Posts in Standard
Improving Outcomes in Utilization Management. Module D. Transdis

Date Available:
NOW

Course Type:
On Demand

This module explains that process by looking at how transdisciplinary and inter-organizational collaboration can help prevent avoidable complications, delays in care, and hospital admissions. The module then details the breadth of the entire team, and looks at how better physician involvement—such as doing bedside rounds, leading the utilization management committee (UMC), and using a physician’s advisor—can help boost effectiveness and efficiency.

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Improving Outcomes in Utilization Management. Module C. Electron

Date Available:
NOW

Course Type:
On Demand

This module explores how utilization management can improve electronic tools—namely, electronic health records (EHR) and other information technology (IT). The module first looks at the relevant data accessed through such tools, such as medical necessity information and discharge plans, and the vital role that EHRs play in preventing unnecessary errors, such as wrong medications or even wrong surgeries.

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Improving Outcomes in Utilization Management. Module B. External

Date Available:
NOW

Course Type:
On Demand

This module looks at the outside entities and processes that shape the process of UM. It begins by looking at the various government and regulatory oversight organizations, including the Centers for Medicare & Medicaid Services (CMS) and The Joint Commission (TJC)— which oversee hospitals—and the National Committee for Quality Assurance (NCQA) and URAC (formerly referred to as the Utilization Review Accreditation Commission), which oversee health plans.

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Improving Outcomes in Revenue Cycle Management. Module D.

Date Available:
NOW

Course Type:
On Demand

This module looks at how working with the Medicare system offers hospitals the opportunity both to maximize its reimbursement system, while also creating a better patient experience. It begins by looking at how hospitals can acknowledge patients as consumers who want the best experience for their money, while also looking at how certain diagnoses can drive up costs for everyone involved, and fast.

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Improving Outcomes in Professional Identity Modules A - F

Date Available:
NOW

Course Type:
On Demand

This course offers evidence-based grounding skills to bridge the gaps in a case manager’s knowledge, skills and practice regarding such skills as critical thinking and emotional intelligence as well as the practice of conflict resolution through negotiation, leadership through collaboration, and the delicate dance of dealing with difficult individuals.

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Improving Outcomes in Population Health Management. Modules A-C

Date Available:
NOW

Course Type:
On Demand

The purpose of the Population Health series is to improve the competencies of: • Managed Care Organization Case Managers (MCO CMs) in managing members who are admitted to hospitals, by providing current information on prior-authorizations, concurrent reviews and transitions of care • Hospital based Case Managers (HCMs) about criteria commercial payers use to make decisions on prior-authorizations, concurrent reviews, and transitions of care of members who are admitted to the hospital

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