Inter-Rater Reliability

The Utilization Management department ensures the consistency with which the clinical staff applies medical necessity criteria by performing inter-rater audits at least annually. Consistent application of medical necessity criteria reduces the potential for waste of health care services. The goal for staff in their role for one year or greater is an aggregate annual score of at least 90 percent. The goal for staff functioning in their role for less than one year is an aggregate annual score of at least 85 percent. Staff who do not achieve the required aggregate score are provided improvement plans and re-audited after the interventions are completed.