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CE Home > Case Management > Utilization Management

Utilization Management    
A Core Course
by Marilyn Fuller Delong, RN, MA and Marie R. Sanders, RN, MSN, CCM and Barbara Quick, RN, MS, CPHQ, CMAC, ACM and Patricia L. Cox, RN, MS and Bernice Chapman, RN, BSN, CCM
60162 l 10.00 hr

Utilization Management - 60162  


        Price  ( $ 64.00 )
Objectives:

This course has been approved for 8 clock hours by the Commission on Case Manager Certification from January 1, 2006 through December 31, 2009 and January 15, 2010 through December 31, 2010.

The purpose of this course is to provide nurses with the basic principles of utilization management. After studying the information presented here, you will be able to —

  • Define utilization management and explain its origins and purpose.
  • Describe the role of the utilization review committee.
  • Identify criteria used in the utilization process.
  • Name five types of review and discuss when each is used.
  • Compare the nursing clinical process to the nursing utilization process.
  • Explain how patient care pathways are influential in the utilization process.
  • Differentiate between Medicare and Medicaid.
  • Describe HMO, PPO, and independent practice association models.
  • Identify two areas within UM that are affected by the Health Insurance.
  • Portability and Accountability Act.
  • Explain the managed care concept and describe how it affects utilization management.
  • Identify three types of data collection that are significant for measuring outcomes in the utilization process.
  • Identify the principal components of criteria for admission, continued stay, and discharge in the mental health and chemical dependency setting.
  • Discuss the role and responsibilities of the utilization professional in the skilled nursing, home health, and external review settings.
  • Identify the legal responsibilities of the utilization professional.
  • List five characteristics of a successful reviewer.

This course will be updated or discontinued on or before 6/24/2012


    Print Options: Book - Add to Cart ($ 64.00 + shipping & handling)
 
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This course completion will be electronically reported to CE Broker as required per Florida Statute 456.025(7). Click here to view your CE Broker transcript and check the status of your CE requirements with a FREE 7-day CE Broker trial subscription. It may take up to 24 hours for the course to appear on your CE Broker transcript.
Gannett Education, formerly known as Nursing Spectrum Division of Continuing Education, is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Accredited status does not imply endorsement by the provider or ANCC of any commercial products displayed in conjunction with this activity. Unless stated above, the planners and authors of this course have declared no real or perceived conflicts of interest that relate to this educational activity.