Utilization Management Workshop Series: Best Practice Applications for the Hospital Setting
All webinars in this 4-part series are scheduled from:
9:00 – 11:00 a.m. Central time
Register once and you are registered for all 4 webinars. Recordings will be available for 60 days after each webinar.
Part 1: Thursday, May 16
Part 2: Thursday, May 23
Part 3: Thursday, May 30
Part 4: Thursday, June 6
This webinar series is $450 per NDHA member hospital; and $550 per non-member hospital.
Audience:
Chief Medical Officer, Chief Nursing Officer, Compliance Officer, Emergency Department Personnel, Joint Commission Coordinator, Medical Records, Quality Improvement personnel, Risk Manager, Legal Counsel.
Overview:
Utilization management has evolved to be much more comprehensive and encompasses elements of resource management as well as denials management. Physicians, are, at times, left out of this important process but must be included in any contemporary case management model that includes utilization management.
This four-part series will introduce the role of utilization management in today’s contemporary case management models. The webinars will focus on the role of RN case managers, social work case managers, and other department staff who collaborate with the role of the RN utilization manager. An example of the day in the life of a utilization case manager will also be shared.
The series will address challenges for implementing the utilization management process and will include tips and strategies for streamlining the process. There will also be an emphasis on the importance of collaboration with physicians, the interdisciplinary team, case management department peers, and payers.
Lastly, documentation of utilization management will be discussed. This will include documentation in the medical record and the role of electronic utilization management software.
Learning Objectives:
– Explain the role of utilization management for the RN case manager.
– Recite best practices for the utilization management role.
– Discuss the compliance requirements for utilization management.
– Record medical necessity criteria in the clinical review process.
– Recall the denial and appeal process.
– Identify clinical review examples to apply the information learned.
Speaker:
Bev Cunningham has been a partner and consultant with Case Management Concepts, LLC, since its inception. Previously, Bev served as the vice president, resource management at Medical City Dallas Hospital where she was responsible for case management, health information management, patient access, solid organ transplant, and transplant financial services. Bev has been involved in the development of case management for over 25 years, and her areas of expertise include the role of the case management in the revenue cycle, compliance for case management departments, the role of the physician advisor, and effective denials and appeal management. She has achieved ACM certification by the American Case Management Association.
Toni G. Cesta is a founding partner of Case Management Concepts, LLC, a consulting company that assists institutions in designing, implementing, and evaluating case management departments and models, educational programs, and onsite support for leadership and staff. She has been active in the research and development of case management for over 25 years. Her research has included two funded studies measuring the effects of a case management model on congestive heart failure and fractured hip patient populations, with measures of patient satisfaction, quality of life, and short- and long-term clinical perceptions and outcomes.
These speakers have no real or perceived conflicts of interest that relate to this presentation.
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