OasisLMS

Part One: Thursday, October 2 (10:00 a.m.-noon ET) 

Part Two: Thursday, October 9 (10:00 a.m.-noon ET) 

Part Three: Thursday, October 16 (10:00 a.m.-noon ET) 

Part Four: Thursday, October 23 (10:00 a.m.-noon ET) 

 

Bev Cunningham has been a partner and consultant with Case Management Concepts, LLC, since its inception. Previously, she served as the vice president, resource management at Medical City Dallas Hospital where she was responsible for case management, health information management, patient access, solid organ transplant, and transplant financial services.

Bev has been involved in the development of case management for over 25 years, and her areas of expertise include the role of case management in the revenue cycle, compliance for case management departments, the role of the physician advisor, and effective denials and appeal management. She has achieved ACM certification by the American Case Management Association.

Toni G. Cesta is a founding partner of Case Management Concepts, LLC, a consulting company that assists institutions in designing, implementing, and evaluating case management departments and models, educational programs, and onsite support for leadership and staff.

She has been active in the research and development of case management for over 25 years. Her research has included two funded studies measuring the effects of a case management model on congestive heart failure and fractured hip patient populations, with measures of patient satisfaction, quality of life, and short- and long-term clinical perceptions and outcomes.

These speakers have no real or perceived conflicts of interest that relate to this presentation.

Utilization management encompasses elements of resource management and denials management. Physicians are often left out of this important process, but they 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 series 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, documentation of utilization management will be discussed.

At the conclusion of this series, participants should be able to:

 

Part One:

• Explain the role of utilization management for the RN case manager.
• Recite best practices for the utilization management role.

 

Part Two:

• Discuss the compliance requirements for utilization management.
• Record medically necessity criteria in the clinical review process.

 

Part Three:

• Recall the denial and appeal process.
• Apply effective strategies for optimal payer communication.

 

Part Four:

• Identify clinical review examples to apply the information learned.

The Georgia Hospital Association Research & Education Foundation is an approved provider of nursing home administrator credits as a professional trade association in long term care under Ga. Comp. R. & Regs. 393-13-.02, (1) (a). Each session of the series is approved for 2 contact hours or a total of 8 contact hours for the full series.

By attending Utilization Management Workshop Series: Best Practice Applications for the Hospital Setting Webinar Series offered by Georgia Hospital Association, participants may earn up to 8 ACHE Qualifying Education Hours toward initial certification or recertification of the Fellow of the American College of Healthcare Executives (FACHE) designation. Attendees who wish to have the hours applied toward ACHE Qualifying Education credit must self-report their participation by logging into their MyACHE account and selecting ACHE Qualifying Education Credit.

If you need assistance with registration, please contact the education department at education@gha.org or 770-249-4529.