Utilization Management: Best Practice Applications

WHO SHOULD PARTICIPATE: CMOs, CNOs, compliance officers, emergency department personnel, case management staff, joint commission coordinators, medical records staff, quality improvement personnel, risk managers, and legal counsel


OVERVIEW: Utilization management has evolved to be much more comprehensive and encompasses elements of resource management as well as denials management. Physicians are, at times, left out of this important process but must be included in any contemporary case management model that includes utilization management. This four-part series will introduce the role of utilization management in today’s contemporary case management models. The webinars will focus on the role of RN case managers, social work case managers, and other department staff who collaborate with the role of the RN utilization manager. The presenters will share example of the day in the life of a utilization case manager. The series will address challenges for implementing the utilization management process and will include tips and strategies for streamlining the process. There will also be an emphasis on the importance of collaboration with physicians, the interdisciplinary team, case management department peers, and payers. Lastly, the presenters will discuss documentation of utilization management. This will include documentation in the medical record and the role of electronic utilization management software.

LEARNING OBJECTIVES:
• Explain the role of utilization management for the RN case manager;
• Recite best practices for the utilization management role;
• Discuss the compliance requirements for utilization management; and 
• Record medical necessity criteria in the clinical review process. 

MEET YOUR FACULTY: 
Toni G. Cesta, PhD, RN, FAAN, Founding Partner, Case Management Concepts, LLC; Speaker Bio   
Beverly Cunningham, MS, RN, Founding Partner, Case Management Concepts, LLC; Speaker Bio 

CONTINUING EDUCATION: Nursing: Up to 8.0 contact hours will be awarded for this offering by the Louisiana Hospital Association for complete attendance and evaluation of the program. The LHA is approved by the Louisiana State Board of Nursing – CE Provider #39. Participants will receive, upon completion of this program and evaluation, a certificate documenting the completed continuing education/clock hours.
When
5/16/2024 9:00 AM - 11:00 AM
Central Daylight Time
Where
Virtual Event UNITED STATES
Registration not available.

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VIRTUAL OFFERING: Access information for the webinar will be provided to each registered participant in advance of the event. To prevent emails from going into your junk or spam folders, have your IT staff whitelist the email address [email protected] and any emails coming from LHAonline.org. Access information and program materials are not meant to be shared with anyone other than registered participants. Program materials are the intellectual property of the speakers and are intended only for those who register and participate in the webinar. Sharing this information with others within your organization will result in being charged an additional registration fee.

REGISTRATION: Registrations are accepted online only. VISA, Master Card, Discover, and American Express are accepted. Email confirmations will be sent to registrants upon completion of registration. To ensure timely delivery of instructions and handouts, and inclusion on the attendee list, registrations should be completed online one week prior to the event.  

CANCELLATION POLICY: Individuals who cancel more than seven business days prior to a scheduled event will be charged a cancellation fee of $40 per person unless the webinar is complimentary. Written notice of the cancellation must be emailed to [email protected]. No refunds will be issued for cancellations received within seven business days of the event or for no-shows. 

SUBSTITUTION POLICY: Registrants who are unable to participate in an LHA educational event are permitted and encouraged to have an eligible substitute; however, written notice of the substitution must be emailed to [email protected] at least seven business days in advance of the event. The substitution option is not available if written notification is received by the LHA less than seven business days before the scheduled program. 

ACCOMODATIONS: Please contact the LHA if you have a disability that may require special accommodations for this educational opportunity. The LHA is committed to ensuring full accessibility for all registrants.