Utilization Management: What Does it Really Mean for Today’s Case Manager

Event Information
Product Format
Prerecorded Event
Presenter(s)
Toni G. Cesta, Ph.D., RN, FAAN
Conference Date
Wed, Aug 24, 2016
Length
60 minutes
Product Description

Learn How To Stream-Line Your Utilization Management Process

 

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.

This session by expert speaker Toni G. Cesta, Ph.D., RN, FAAN 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.

Session Highlights:

  • Learn how to stream-line your utilization management process
  • Understand the compliance components of utilization management
  • Remove the myths about the Conditions of Participation for Utilization Review
  • Learn strategies  for passing a survey on the Conditions of Participation
  • Determine whether your utilization review committee is in compliance
  • Examples of utilization review committee reports
  • How to incorporate the two midnight rule into your utilization management process
  • Review the types of HINNs – Hospital-Issued Notice of Non-Coverage

Key Learnings:

  • The differences between utilization review and utilization management
  • The definition of medical necessity
  • How to balance financial and clinical medical necessity
  • Compliance as it relates to utilization management
  • Conditions of participation for utilization review
  • Components of a compliant utilization review plan
  • Components of a compliant utilization review committee
  • Condition Code 44
  • Provider Liable
  • Guidelines for utilization review surveys
  • Guidelines for admission and continued stays
  • Clinical aspects affecting medical necessity
  • Three types of utilization management
  • Utilization management and access point case management
  • Sample utilization management reports
  • The two-midnight rule and utilization management
  • Hospital Issued Notices of Non-Coverage – HINNs
  • Denial management as a component of utilization management

Who Should Attend

  • Directors of Case Management
  • Directors of Social Work
  • Discharge Planners
  • Social Workers
  • RN Case Managers
  • Physician Advisors
  • Directors of Compliance
  • Directors of Quality and Outcomes

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Order Below or Call 1-866-458-2965 Today

You can also order through:
Phone

1-866-458-2965

Fax

1-919-287-2643

About Our Speaker

Toni G. Cesta - Healthcare Case Management Expert

Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, providing on-site education to case management staff, and strategies for assisting health care organizations in improving their case management department’s efficiency and effectiveness.


The author of nine books, and...   More Info
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