Utilization management was the first role applied in acute care case management models.  It was first known as utilization review but has evolved into something much more comprehensive. Today it encompasses elements of resource management and denials management as well.  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 streamlining the process and making it as efficient as it can be.  Required compliance for utilization management processes will also be addressed.  Lastly, there will be a focus on incorporating the role of utilization management with the other roles of case management:  resource management, discharge planning, and care coordination.

Session Outline:-

• The business of case management
• Utilization review and utilization management:  the difference
• Compliance of utilization management
• Access points for utilization management
• Types of utilization management
• Denial management
• Incorporating utilization management into case management rules and functions
• Physician relationships:  Attending physician, consulting physician, and physician advisor

Learning Objectives:-

• Describe the differences between utilization review and utilization management
• Discuss the best practice utilization management strategies to manage an effective case management department
• Identify ways in which a strong utilization management process can reduce payment denials
• Ensure effective physician relationships in the utilization management process.

Why Should You Attend?

With the increased focus on the value of hospital case management, it is imperative that case management professionals understand not only the role of utilization management but how to integrate with other case management roles and functions.  Many hospitals are not able to provide a comprehensive didactic orientation program for their new staff.  This program will provide that, as it relates to utilization management.  This will also be a helpful review and update for seasoned case management staff.

Who Should Attend?

• Director of Case Management
• RN Case Managers
• Director of Finance
• Director of Social Work
• Social Workers
• Hospitalists
• Physician Advisors
• Chief Medical Officers