8 DECEMBER 2025Pediatric Utilization Management Through a Leadership LensBy Bourque Maryanne, Director, Utilization Management, Nurse Case Management and Complex Scheduling, NemoursPATIENT-CENTERED UTILIZATION MANAGEMENT AND TECH-DRIVEN IMPROVEMENTSAlthough utilization management is designed to be an objective review of medical necessity and progression of care, I've always approached this discipline with a strong patient advocacy focus. As patients, especially pediatric patients, are not always in a position to advocate for themselves, I've always considered a key part of my role to be looking for barriers to care and timely access to care, as well as how disparities affect the way patients receive care.I've always established performance metrics and worked with teams to clearly understand not just expectations but how to meet those expectations. I've also worked to incorporate continuous improvement processes to ensure the best outcomes. Nemours' philosophy of child- and family-centered care aligns strongly with my own beliefs: when you prioritize what's best for patients and families, best practices and excellent care naturally follow.Some of the advancements are technological and some are low-tech but highly impactful:· Referrals to complex scheduling previously came into the team in a variety of ways, through referrals, emails and even faxes. We worked with our EMR team to develop a work queue that provided transparency in work, along with the ability to prioritize based on patient need and Bourque Maryanne, director of utilization management, nurse case management and complex scheduling at Nemours, brings a strong foundation in nursing, pediatrics and healthcare management. Her early NICU, Transport and ED experience shaped her focus on care quality and system efficiency. Leadership roles sharpened her strategic skills, while cross-disciplinary collaboration at Nemours fuels her commitment to innovation and improved outcomes.Bourque MaryanneIN MY OPINION
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