What does the term "utilization review" refer to?

Utilization review is a systematic process that aims to assess the necessity, appropriateness, and efficiency of healthcare services provided to patients. This process is crucial in ensuring that patients receive quality care while also managing healthcare costs effectively. By evaluating the services rendered, healthcare providers can determine whether they are justified based on established criteria, such as clinical guidelines and the patient's individual health needs.

This evaluation helps to avoid unnecessary procedures and treatments, thus promoting better patient outcomes and resource management. It plays a significant role in insurance and managed care settings, as it informs decisions related to coverage and reimbursement based on the evaluation of services rendered.

The other options do not accurately capture the essence of utilization review. For instance, while insurance claims approval is related to financial transactions, it does not focus on the clinical evaluation of services. Similarly, managing healthcare staff and tracking patient demographics pertain to operational and administrative functions rather than the clinical assessment of healthcare services.