| A | B |
|---|
| Worker compensation | Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment. |
| Utilization Review | Utilization review involves managed care techniques like prior authorization to assess the appropriateness of healthcare services before they are provided, helping payers manage the cost.. |
| Claimant | Injured worker that receives benefits from worker’s compensation. |
| Providers | Anyone who rendered service/s to an injured worker. |
| Claim Adjuster | Someone who investigates insurance claims to determine the extent of the insuring company's liability. |
| Nurse Case Managers | They ensure proper utilization of services and resources as well. Case managers provide assistance within, between, and outside of facilities. |
| Clinical Nurse Reviewers | Nurses (mostly USRNs) who review cases. |
| Clinical Peer Reviewers | Physicians who review and make determinations for cases that cannot be approved by a clinical nurse. |
| Determination | Result of the utilization review. This can be certified, non-certified or partially certified. |
