Utilization Management: Rules, Regs and How To's

Case Management Bootcamp Part 2 of 5 (view all sessions)

Overview:

Utilization management was the first role applied in acute care case management models. It was first known of as utilization review but has evolved into something much more comprehensive than that. Today it encompasses elements of resource management and denials management as well. Physicians, both the practicing physician and the physician advisor are often left out of this important process and must be included in any contemporary case management utilization management model. This program will review the role of utilization management as it applies to today’s contemporary case management models. Included will be best-practice suggestions for your practice 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 in the case management role, whether it is housed with the RN case manager role or outside of it.

Objectives:

• Describe the differences between utilization review and utilization management
• Discuss the best strategies for managing utilization reviews and other issues relate to utilization management
• Identify ways in which a strong utilization management process can reduce payment denials

CE’s: NHA & SW

Presenter: Toni Cesta, Ph. D, RN, FAAN, Founder, Case Management Concepts, LLC

Toni G. Cesta, Ph.D., RN, FAAN is a founding partner of Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing, and evaluating case management departments and models, educational programs, onsite support for leadership and staff.

Dr. Cesta is the author of nine books in the field of case management, a frequently sought-after speaker, lecturer, and consultant, and is considered one of the primary thought leaders in the field of case management. Dr. Cesta also writes a monthly column called “Case Management Insider” in Relias Media’s Hospital Case Management newsletter in which she shares insights and information on current issues and trends in case management.

Dr. Cesta has been active in the research and development of case management for over 25 years. Her research in case management has included two funded studies measuring the effects of a case management model on congestive heart failure and fractured hip patient populations, with measures of patient satisfaction, quality of life, and short- and long-term clinical perceptions and outcomes.

Registration:

Registration is free for SDAHO Members and $49 for Non-Members.

Click here to register.