Case Management and Utilization Review Essential Skills Online Learning

Overview

Case Management and Utilization Review Essential Skills Online Learning is comprehensive training for case managers on the floor, as well as those who are directors or managers. This library provides the core skills vital to get staff up to speed in an engaging, interactive learning format by providing popular topics essential to case management and covering them in great detail.

The library consists of 10 courses:

• Emergency Department Case Management Essential Skills: An outline of critical roles that the ED case manager plays in the organization, and how to set up an efficient and effective infrastructure for the position to ensure it achieves its purpose.
• Managing Long Length of Stay Patients: Guidance for identifying the challenges associated with long length of stay patients, plus strategies case managers can use to overcome barriers and expedite care when possible.
• Delivering and Completing Appropriate Patient Notices: An overview of some of the main notices that case managers will encounter from government programs and private insurers or third-party payers, including the following:
  • Important Message from Medicare
  • Hospital-Issued Notice of Noncoverage
  • Reinstatement letter 
  • Medicare benefit exhaust letter
  • Advance beneficiary notice
  • Noncoverage letters issued by an insurer, third-party payer, or medical group
• Enhancing Case Manager and Physician Communication and Collaboration: A discussion of the challenges that mark case manager/physician relationships and the strategies that can be used to overcome those challenges.
• Utilization Review and Utilization Management for Case Managers: The case manager’s role in utilization review (UR) and utilization management (UM), including how to determine whether a case meets medical necessity and other Medicare requirements.
• The Role of Case Managers in Addressing the Social Needs of Patients: Charity Care, Community Resources, and More: Strategies for addressing social needs, including screening, working with primary care physicians, accessing charity care, and linking patients with community organizations.
• Case Management Strategies for Assisting Challenging Patients: An overview of resources to help patients who are working through unique or difficult circumstances, which is critical to providing solutions that can assist in overcoming the barriers they face.
• Patient Status Essentials for Case Managers: A focus on the challenge of ensuring accurate patient status assignments.
• Population Health in Case Management: Strategies for setting goals for a population health program, identifying high-risk patients, working with common elements to improve care for complex patients, and strengthening care through disease-specific, evidence-based practices.
• The Role of Case Managers in Transfers, Discharges, and Readmissions: A discussion about the case manager’s role as the patient moves from the hospital into another setting of care, whether through transfer or discharge.

Case Management and Utilization Review Essential Skills Online Learning

Course Objectives

Upon completion of the courses in this library, students will be able to:

• Describe different ED case management models
• Examine case management’s role in length of stay
• Identify the requirements for patient notices of coverage denials
• Examine how a physician advisor can be an important ally for case management and help smooth relations with physicians
• Describe the case manager’s role in utilization review and utilization management
• Identify how social needs can affect a patient’s health and well-being
• Identify strategies to help prevent avoidable readmissions among patients with unique challenges
• Discuss the role of the case manager in ensuring correct patient status assignments and in supporting physicians’ status determinations
• Identify how population health programs can help organizations transition to the value-based healthcare model
• Describe the case manager’s role in moving the patient to the next level of care, whether through a transfer or discharge

Case Management and Utilization Review Essential Skills Online Learning

Course List

• Emergency Department Case Management Essential Skills
• Managing Long Length of Stay Patients
• Delivering and Completing Appropriate Patient Notices
• Enhancing Case Manager and Physician Communication and Collaboration
• Utilization Review and Utilization Management for Case Managers
• The Role of Case Managers in Addressing the Social Needs of Patients: Charity Care, Community Resources, and More
• Case Management Strategies for Assisting Challenging Patients
• Patient Status Essentials for Case Managers
• Population Health in Case Management
• The Role of Case Managers in Transfers, Discharges, and Readmissions

Case Management and Utilization Review Essential Skills Online Learning

Continuing Education

Accreditation Council for Continuing Medical Education (ACCME)
HCPro is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

HCPro designates this educational activity for a maximum of 4.75 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity

American Nurses Credentialing Center (ANCC)
HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This educational activity for 4.75 nursing contact hours is provided by HCPro.  

Commission for Case Manager Certification (CCMC)
This program has been pre-approved by the Commission for Case Manager Certification to provide continuing education credit to CCM board certified case managers. The course is approved for 3.75 CE contact hours.

California Board of Registered Nurses
HCPro is approved by the California Board of Registered Nursing to provide 5.7 nursing contact hours. California BRN Provider #CEP 14494.

Case Management and Utilization Review Essential Skills Online Learning

Contributor Bio

June Stark, RN, BSN, MEd, has been a director of case management and social work for more than 18 years in both major Boston teaching hospitals and community-based hospitals. Currently, she is the director of case management and social work at St. Elizabeth’s Medical Center in Boston.

Stark’s long-time experience in case management provides her a unique perspective and understanding of case management’s role, operations, and systems. She shares her expertise as an adjunct facility member at the Regis College School of Nursing in Weston, Massachusetts, where she has taught on case management and care coordination since 2012. She has been teaching a case management certification course at the University of Southern Maine since 1998. Stark is an editorial advisory board member and regular contributor to HCPro’s Case Management Monthly newsletter.

Case Management and Utilization Review Essential Skills Online Learning

Train your staff?

To train a group or to purchase multiple courses, please call 615-724-7200 or email pd-is@simplifycompliance.com.

Case Management and Utilization Review Essential Skills Online Learning

Terms

You will have access to your Case Management and Utilization Review Essential Skills Online Learning for one year from the purchase/order date.