Improving Outcomes in Utilization Management

Course #UM21182016

Total Course Available CE Credits: 7.5 (all modules)

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Course Directors:

Brian K. Pisarsky, RN, MHA, ACM, CPUR
System Administrative Director of Resource Management
DCH Health System – Tuscaloosa, Ala.

Teresa Fugate, RN, BBA, CCM, CPHQ
Medicare STARS Strategic Consultant
Humana – Louisville, Ky.

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Description: Ongoing and far-reaching changes in the United States healthcare industry have greatly increased the challenges healthcare organizations face today. This course looks at how the practice of utilization management—a patient-centered but cost-conscious approach to offering the right treatment at the right time—is a vital element in improving the health of patients and healthcare organizations. The five modules lay out the dynamics of UM, the external forces that shape it, and the technology to establish effective UM; the modules then look at good UM in action, with participation from the transdisciplinary team and using certain practices to measure results, which can help patients get better care while lowering costs.

Business goals: After completing this module, case managers can expect to:
» Improve utilization of resources and reduce LOS by 15 percent
» Reduce over-utilization of resources by 10 percent

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Course Modules

Module A: Dynamics and Structure

Module B: External Forces

Module C: Electronic Information Technology in UM

Module D: Transdisciplinary Care

Module E: Key Quality Measurements