Santa Rosa Rehabilitation Hospital in San Antonio, TX, not unlike many healthcare facilities throughout the nation, was faced with several issues: (a) increased cost, (b) lower reimbursement, (c) high length of stay, and (d) low staff morale. The management team was responsible for developing a system to control these issues, the most noticeable and measurable of which was length of stay. In 1987, the facility reached a high length of stay of 43 days. In response, the managers of Santa Rosa Rehabilitation Hospital took the lead in instituting multidisciplinary utilization management, and the hospital saw the average length of stay decrease to 18 days in 1990. This article provides a detailed description of the development of multidisciplinary utilization management, as well as a brief history of the rationale behind the utilization management process. Limitations and advantages of the system also are described.