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Utilization Management - 60162
Utilization Management
A Core Course


60162 l 10.00 contact hrs
by Teresa M. Treiger, MA, RN-BC, CHCQM-CM/TOC, CCM
Average Rating
(4.5 / 3674 reviews)
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CE OVERVIEW REVIEWS     
Objectives:
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 goal 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 UM and explain its origins and purpose
  • Describe the role of the UR committee
  • Identify criteria used in the UM process
  • Name 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 various managed care 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 UM
  • 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


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

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