Attend this webinar to understand hospital utilization management despite demanding payers doing everything they can to deny payment through denial of medical necessity. Learn about the best model of case management, denial management, and best practices in clinical reviews.
Utilization management is a challenging process. Payers are demanding and are doing everything they can to deny payment through denial of medical necessity. Case management leaders struggle with determining the best model of case management, the optimal roles and the place where utilization management should reside—as a functional role of a bedside RN case manager or separate from that role.
Denial management requires critical thinking by RN case manager and can be both time-sensitive and time-consuming. Payer rules and regulations drive the need for timeliness of the UM process. Rules and regulations by different payers are challenging to both understand and operationalize.
The relationship of physicians to the UM process is critical. Engaged and effective attending physicians, consulting physicians and physician advisors are key in a successful case management program.Areas Covered in the Webinar:
Consultant, Case Management Concepts LLC
Bev Cunningham, MS, RN, ACM is a founding partner of Case Management Concepts, LLC. She has a 25-year deep working knowledge of case management with specific expertise in denials management, patient flow and the role of the Case Manager and Social Worker in the Case Management process. Bev is also a certified case manager with the American Case Management Association. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital.
She has co-authored a book for hospital case managers—Core Skills for Hospital Case Managers and has written the utilization management chapter in the past two editions of CMSA’s book, Core Curriculum for Case management.
Registrants may cancel up to two working days prior to the course start date and will receive a letter of credit to be used towards a future course up to one year from date of issuance. FDATrainingAlert would process/provide refund if the Live Webinar has been cancelled. The attendee could choose between the recorded version of the webinar or refund for any cancelled webinar. Refunds will not be given to participants who do not show up for the webinar. On-Demand Recordings can be requested in exchange.
Webinar may be cancelled due to lack of enrolment or unavoidable factors. Registrants will be notified 24hours in advance if a cancellation occurs. Substitutions can happen any time.
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