Care Excellence Logo

Care Excellence

Training for Case Managers

  • Home
  • Health Plan Training
    • Foundational
      • Case Management Principles
      • Motivational Interviewing
      • Motivational Interviewing Practicum
      • Relationship Building
      • Getting the Whole Picture
      • Care Planning
    • Advanced
      • Patient-Value Perception
      • Special Populations I
      • Special Populations II
      • Complex Care Coordination Skills
      • Complex Care Coordination Interventions
    • Leadership
      • Best Practices for Improved Outcomes
      • Mentorship
      • Leadership
      • Innovation
  • Hospital Training
    • Foundational
      • Principles of Care Management
      • Crisis Intervention and Management
      • Relationship Building
      • Care Coordination Skills
      • Crisis Communication Practicum
    • Foundations of Utilization Review
    • Advanced
      • Patient Satisfaction and Healthcare Quality
      • Effective Care for High-Need Patients I
      • Effective Care for High-Need Patients II
      • Administrative Functions
    • Leadership
  • Blog
    • News
  • EBooks
    • Building Healthy Boundaries
    • Strategies for Supporting Self-Management Programs
    • Gratitude: Self-Care Strategies
    • Successful Care Manager
    • Going Beyond Creativity
    • Power of Words
  • About
  • Contact

Foundations of Utilization Review

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

Join the Interest List!

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.

Course Information

DATE: Register Anytime
LOCATION: Online
COST: $728 per course (see module description for individual pricing)
CONTINUING EDUCATION HOURS: 24 Hours

QUESTIONS:
Contact Us About This Course

Register for Case Management Education

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: $728 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

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.

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

GET YOUR COMPLIMENTARY EBOOK!

Care Excellence Ebook

“Patient Engagement & Patient Activation: Strategies for Supporting Self-Management Programs”

This eBook examines the evidence base surrounding patient engagement that leads to effective self-management, models that enhance patient activation, and more.

Sign up by clicking HERE or the image of the eBook.

Course Information

DATE: Register Anytime
LOCATION: Online
COST: $728 per course (see module description for individual pricing)
CONTINUING EDUCATION HOURS: 24 Hours

QUESTIONS:
Contact Us About This Course

Register for Case Management Education

Back to Top

X

Contact Us About This Case Management Course

First Name (required)

Last Name (required)

Your Email (required)

Phone Number

Your Message (required)

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!

    • Utilization Review Care Management Concepts

      DATE: Register Anytime
      LOCATION: Online
      COST: $168
      CONTINUING EDUCATION HOURS: 6 Hours

      This module provides an historical evolution of utilization management, an overview of the roles and responsibilities of a utilization review specialist, credentials required, the types of reviews they perform, information on the type of health insurance plans with which they interact, and the value they bring to the hospital team related to optimizing appropriate use of hospital resources.

      Join the Interest List

      OR

      Register Now

      X

      Join the Interest List!






    • Utilization Review Principles of Practice

      DATE: Register Anytime
      LOCATION: Online
      COST: $168
      CONTINUING EDUCATION HOURS: 6 Hours

      As part of the team that guides patients through their hospitalization and payment systems, care managers and utilization review managers share several responsibilities informed by a clear understanding of issues such as confidentiality, informed consent, patient rights, and other factors. This module explores the fundamentals of utilization review case management, from ethics to counseling considerations to reimbursement for inpatient hospital care.

      Join the Interest List

      OR

      Register Now

      X

      Join the Interest List!






    • Utilization Review Health Care Management & Delivery

      DATE: Register Anytime
      LOCATION: Online
      COST: $84
      CONTINUING EDUCATION HOURS: 3 Hours

      This course provides an overview of the key factors that created today’s care management models: healthcare delivery systems, professional educational requirements, healthcare innovations, advocacy groups, governmental engagement, and payment models.

      Join the Interest List

      OR

      Register Now

      X

      Join the Interest List!






    • Utilization Review Legal Issues & Hospitals

      DATE: Register Anytime
      LOCATION: Online
      COST: $112
      CONTINUING EDUCATION HOURS: 4 Hours

      This module delivers an overview of common legal issues encountered in hospital utilization management. It explores the key elements of EMTALA, requirements of the CARE Act, the utilization review manager’s responsibility as a mandated reporter, CMS utilization review, the Anti-Kickback Statue, various compliance requirements, and a healthcare provider’s responsibility under the exclusion act.

      Join the Interest List

      OR

      Register Now

      X

      Join the Interest List!






    • Pediatric Utilization Review

      DATE: Register Anytime
      LOCATION: Online
      COST: $140
      CONTINUING EDUCATION HOURS: 5 Hours

      This module provides an overview of unique issues related to the care of children and their families; common conditions, symptoms, and care management considerations in pediatric populations that the utilization review professional may encounter; insurance and coverage issues for children; and important issues to consider related to discharge planning to optimize transitions in care across the care continuum.

      Join the Interest List

      OR

      Register Now

      X

      Join the Interest List!






Course Information

DATE: Register Anytime
LOCATION: Online
COST: $728 per course (see module description for individual pricing)
CONTINUING EDUCATION HOURS: 24 Hours

QUESTIONS:
Contact Us About This Course

Register for Case Management Education

Back to Top

X

Join the Interest List!







Course Information

DATE: Register Anytime
LOCATION: Online
COST: $728 per course, (see module description for individual pricing)
CONTINUING EDUCATION HOURS: 24 Hours

QUESTIONS:
Contact Us About This Course

Register for Case Management Education

Join the Interest List for this Course

  • Home
  • Foundational
  • Advanced
  • Leadership
  • News
  • Contact