Utilization Management: Best Practice Applications
WHO SHOULD PARTICIPATE: CMOs, CNOs, compliance officers, emergency department personnel, case management staff, joint commission coordinators, medical records staff, quality improvement personnel, risk managers, and 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. The presenters will share example of the day in the life of a utilization case manager. 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, the presenters will discuss documentation of utilization management. 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; and
• Record medical necessity criteria in the clinical review process.
MEET YOUR FACULTY:
Toni G. Cesta, PhD, RN, FAAN, Founding Partner, Case Management Concepts, LLC; Speaker Bio
Beverly Cunningham, MS, RN, Founding Partner, Case Management Concepts, LLC; Speaker Bio
CONTINUING EDUCATION: Nursing: Up to 8.0 contact hours will be awarded for this offering by the Louisiana Hospital Association for complete attendance and evaluation of the program. The LHA is approved by the Louisiana State Board of Nursing – CE Provider #39. Participants will receive, upon completion of this program and evaluation, a certificate documenting the completed continuing education/clock hours.
Registration
Registration not available.