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Utilization Management - 60162
Utilization Management
A Core Course

60162 l 10.00 contact hrs
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 and Carol Ruscin, RN, MSN, CCM
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This course has been approved for 8 hours by the Commission on Case Manager Certification for 1/15/10 through 12/31/10, 2011, 2012, 2013, 2014, and 2015.
The purpose of this utilization review continuing education program 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 management 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 utilization management that are affected by the Health Insurance Portability and Accountability Act
  • Explain the managed care concept and describe how it affects utilization management
  • Describe 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
  • Describe the legal responsibilities of the utilization professional
  • List five characteristics of a successful reviewer

This course will be updated or discontinued on or before 5/23/2015

    Print Options: Book - Add to Cart ($ 64.00 + shipping & handling)

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Please see CE Course Instructions to learn how to earn CE credit for this module.

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.

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