Utilization Management: Best Practice Applications for the Hospital Setting

Via Webinar Only - Recording of session available to those that cannot attend live sessions.   

This four-part series will introduce the role of utilization management as it applies to today’s contemporary case management models  These webinars will focus on understanding the utilization management processes for RNs assigned to this role. Also included in the webinars will be an example of the day in the life of a utilization case manager. Challenges for implementing the utilization management process will be addressed.  Included will be best-practice suggestions for your role of utilization management with tips and strategies for stream-lining the process and making it as efficient as it can be. Additionally, discussed with be the importance of utilization management collaboration with physicians, the interdisciplinary team, and payers. Lastly, documentation of utilization management will be incorporated. This will include documentation in the medical record (what is appropriate and where do you document) and the role of an electronic utilization management software.

Objectives

• Understand the role of utilization management for the RN case manager.
• Review best practices for the processes used to perform this role.
• Discuss the compliance requirements for utilization management.
• Apply medical necessity criteria into the clinical review process.
• Use clinical review examples to apply the information learned.

Instructors: Toni Cesta & Bev Cunningham, Principals at Case Management Concepts, LLC

Who Should Attend:  RN Case Managers, Hospitalists, Physician Advisors, CFO’s, & anyone responsible for Case Management.

Schedule

February 1, 2024 1:00 - 2:30 pm - Session 1

Introduction to Utilization Management (UM)

• Fundamentals of Utilization Management in the Case Management process.

February 8, 2024 1:00 - 2:30 pm - Session 2

Rules and Regulations Impacting Utilization Management

• Compliance with rules and regulations related to UM.

February 15, 2024 1:00 - 2:30 pm - Session 3

Implementing an Effective Denial and Appeal Approach to Utilization Management  

• Strategies to manage potential denials before they occur.

February 22, 2024 1:00 - 2:30 pm - Session 4

Application of the Utilization Management Process

• Applying concepts using real-life case studies.

Continuing Education:  Clock Hours:  1.5 per session (6.0 Total)         
It is the  responsibility of the attendee to determine whether these activities meet the current criteria for continuing education.  Application is being made to the following agencies: MN Board of Nursing and MN Board of Social Work. The # of CEU’s will be indicated on the  certificate of attendance provided to each participant who attends the session. 

All registrants will receive course information, connection details, & any materials prior to the session. All registrants will receive the webinar recording following the event.

Registration Fees:

Medi-Sota Members: $150/Person

Non-Medi-Sota Members: $300/'Person

Cancellations must be made no later than 10 business days prior to the course. The full course fee will be charged if cancellation is made in less than 10 business days. Full refunds will be given for all classes cancelled by Medi-Sota. Registration is transferable to another person.