Product Details

 

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.

Are you ready to handle cases in 2019?

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

 

Agenda topics:

- 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!

 

After this webinar participants will be able to:

1. Describe the differences between utilization review and utilization management.
2. Discuss the 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.

Your order includes:  

• Recording of the presentation.
• Access to the specially created presentation handouts.

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 Relias 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.