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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.
|- 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|