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Utilization management was the first role applied in acute care case management models. It was first known 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. Additionally, discussed will 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.
CCMC: The Commission for Case Manager Certification certifies case managers and provides valuable continuing education credits for Case Management Advisor and Hospital Case Management. The CCMC is non-profit and the largest nationally accredited organization certifying case managers. The commission prides itself on promoting quality practice, ethical standards and behavior, science-based knowledge development, and raising awareness of the role of case managers
ANCC: Relias LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Contact hours [1.0] will be awarded to participants who meet the criteria for successful completion. California Board of Registered Nursing, Provider CEP#13791.
This CE activity available for streaming on May 11th, 2020
This CE activity is valid until May 11th, 2023.