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Utilization management was the first role applied in acute care case management models. It was first known of as utilization review but has evolved into something much more comprehensive than that. Today it encompasses elements of resource management and denials management as well. Physicians, both the practicing physician and the physician advisor are often left out of this important process and must be included in any contemporary case management utilization management model. This program will review the role of utilization management as it applies to today’s contemporary case management models. Included will be best-practice suggestions for your practice with tips and strategies for stream-lining the process and making it as efficient as it can be.
The challenge of managing the UM process with various payers and varied payment models will also be addressed. Additionally, discussed with be the importance of utilization management collaboration in the case management role, whether it is housed with the RN case manager role or outside of it.
|- Utilization management definition||- Medical necessity defined||- Compliance components of medical necessity|
|- Billing and reimbursement||- Best practice in clinical reviews||- Managing utilization from the bedside|
|- Appropriate UM documentation||- Proactive denial management||And more!|
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