Product Details

 

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Utilization management was the first role applied in acute care case management models. Today, it encompasses elements of resource management and denials management. Physicians are often left out of this important process and must be included in any contemporary utilization management model.  

This program will review the role of utilization management as it applies to today's contemporary case management models. Our experts will provide best-practice suggestions with tips and strategies for stream-lining the process. They will also discuss the importance of utilization management collaboration in the case management role.

Effectively use utilization management.

Call us at 800.688.2421 or add this event to your cart above.

 

Agenda topics:

- Separating UM from CM functions	- Utilization review vs. management	- UM process for medical necessity
- Medical necessity	- Utilization management CoPs	- UM billing & reimbursement
- Essential CM activities	- Clinical review best practices	- UM documentation
- Managing denials	- Practicing physicians	- UM committee physicians
- Physician collaboration in UM	- Utilization management	And so much more!

 

After this webinar participants will be able to:

1. Describe differences between utilization review and utilization management.
2. Discuss best strategies for managing utilization reviews and other issues relate to utilization management.
3. Identify ways in which a strong utilization management process can reduce payment denials.

About Your Speakers:

Toni Cesta, PhD, RN, FAAN is a founding partner of Case Management Concepts, LLC. Dr. Cesta is the author of eight books, a frequently sought-after speaker, lecturer and consultant and is considered one of the primary thought leaders in the field of Case Management. Dr. Cesta also writes a monthly column called Case Management Insider in AHC Media’s Hospital Case Management newsletter. She has been active in the research and development of Case Management for over 20 years.

 

Beverly Cunningham, MS, RN is a founding partner of Case Management Concepts, LLC.  She has a 25-year deep working knowledge of case management with specific expertise in denials management, patient flow and the role of the Case Manager and Social Worker in the Case Management process. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital.