This interactive, self-paced online course is designed specifically for utilization review professionals in acute-care settings who need expert skills and strategies focused on examining costs, improving efficiencies, and ensuring patients receive the highest quality care.
Case Management Training Made Easy – Take the Whole Course or Individual Modules
Developed by experts in hospital case management, in collaboration with the California Hospital Association, this self-paced curriculum comprises five modules:
- Utilization Review Case Management Concepts
- Utilization Review Principles of Practices
- Utilization Review Health Care Management & Delivery
- Utilization Review Legal Issues & Hospitals
- Pediatric Utilization Review
This course is perfect for utilization review nurses, care managers, and other utilization review professionals working in acute care, skilled nursing, long-term care or clinic settings.
Foundations of Utilization Review has been pre-approved by the Commission for Case Manager Certification (CCMC) to provide 24 hours continuing education credit to Certified Case Managers (CCMs).
Learners will master a wide range of learning objectives, including how to:
- Recognize key events leading to development of the health insurance industry and the legislation that drove creation of utilization management
- Describe the three types of utilization reviews and activities associated with each
- Explain the different parts of Medicare and recognize the differences of how Medicare reimburses inpatient, outpatient, and observation services
- Understand the differences between healthcare delivery systems and insurance plans within the context of value-based renumeration for services
- Decipher acronyms and learn the verbiage inherent to working in a utilization management environment
- Explain reporting responsibilities of mandated reporters regarding child abuse, elder abuse, and domestic violence.
- Explain how to integrate a Code of Ethics to a professional practice.
- Discuss the process required to establish and implement a discharge plan
- Define protected health information (PHI)
- Review the role of the utilization review RN on the interdisciplinary team
- Explain reimbursement under value-based purchasing, the importance of the denial and appeal process, and the role and responsibilities of the physician advisor in utilization management
- Evaluate changes in the healthcare system and care management due to governmental engagement, and examine how payment models define care management models
- Explain key elements of EMTALA, an appropriate transfer under EMTALA, and penalties for violation of EMTALA
- List requirements of the CARE Act
- Explain key elements of CMS utilization review Conditions of Participation
- Understand key components of the facility’s utilization management plan, the form and function of the utilization management committee, and various compliance requirements, such as Important Message from Medicare, MOON, HINN notices
- Explore other utilization management considerations (2 Midnight Rule, Status Reconciliation, and 3 Day SNF Rule)
- List unique issues related to the care of children and their families, and common conditions and symptoms among pediatric patients in acute care settings
- Demonstrate an understanding of specific insurance and coverage issues for children with serious and chronic illnesses
- Formulate a framework for discharge planning for pediatric patients that optimizes transitions in care across the care continuum
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Course Modules |
Care Excellence’s courses for hospital care managers have been designed to give you exactly what you need, when you need it. Utilizing a state-of-the-art learning management system, the curriculum is interactive and engaging, utilizing case studies, pre- and post-tests, and other resources to maximize learning and retention. Take the entire Foundations of Utilization Review course, or laser focus your training on any combination of the modules below to address specific challenges.
Call us at 760-750-4006 to purchase multiple modules or if you need assistance designing a custom combination of solutions!
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Fast Facts |
The Foundations of Utilization Review course is available online and can be purchased both in its entirety or piecemeal by modules. Please call us for more information.
| Is taught: | Completely online, via self-paced courses |
| Begins: | Online modules are available immediately upon registration |
| Costs: | $672 per course (see module description for individual pricing) |
| Requires: | Computing skills sufficient to complete graduate work, access to a computer with an Internet connection. |
| Is ideal for: | New or experienced inpatient care managers, care coordinators, or discharge planners working in hospitals, skilled nursing centers, long-term care facilities, and more |
| Provides: | 24 Continuing Education hours upon successful completion |
| Refund Policy: | Course is non-refundable once it has been accessed |