Hospital Case Management Utilization Management: At the Bedside or Centralized?

Duration 60 Mins
Level Basic & Intermediate
Webinar ID IQW21A0110

  • Foundational roles of hospital case management
  • Utilization review versus utilization management
  • Medical necessity
  • Rules and regulations for utilization management
  • 2-Midnight Rule
  • Best-practice utilization management: The principal
  • Integrated model versus triad model of utilization management
  • Advantages and challenges of each model
  • Role collaboration for each model
  • Making your decision as a leader
  • Artificial Intelligence and utilization management
  • Utilization management’s future

Overview of the webinar

As hospital case management departments have evolved and matured, leaders are required to evaluate models and roles. Typically, all four roles of utilization management, care coordination, discharge planning and resource management have functioned at the bedside.  With the challenge of lack of candidates to fill all positions, as well as the challenge of payers and rules, requirements and regulations, hospital case management leaders are evaluating the appropriate place for utilization management to reside.  

There are challenges and advantages of each location for utilization management. As these decisions for hospital case management leaders have arisen, another entrance in the hospital case management realm has come in to being—Artificial Intelligence. 

As these critical decisions are being made, leaders must determine the appropriate location for utilization management in their facility, as well as the best method for performing utilization management. This requires strategy, planning, appropriate roles, collaboration and optimal outcomes. These will all be discussed in the webinar.

Who should attend?

  • Directors of Case Management 
  • RN Case Managers 
  • Social Work Case Managers 
  • Directors of Social Work 
  • Physician Advisors 
  • Chief Medical Officers 
  • Executives Responsible for Case Management

Why should you attend?

With the focus on accuracy and efficiency in hospital case management, all four case management roles are being examined. These roles include utilization management, care coordination, discharge planning and resource management. The role that has the most intense scrutiny is that of utilization management. This role can be quite challenging as payers, especially manager Medicare and managed Medicaid payers have varying rules and regulations. These rules and regulations can change frequently.  

As case management departments are challenged with ensuring all roles are filled and that all staff is working at the top of their license, both efficiently and compliantly, hospital case management leaders are evaluating the place where utilization management should reside—at the bedside……..or centralized?

This webinar will review both models of utilization management and give the attendee understanding of the pros and cons of each mode

Faculty - Ms.Beverly Cunningham

Beverly Cunningham 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. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board.

Bev is also former Vice President Resource Management at Medical City Dallas Hospital where she had responsibility for Case Management, Health Information Management, Patient Access, Physician Integration and Solid Organ Transplant.  As a Clinical Assistant Professor for the Master of Nursing Program at the University of Oklahoma, she coached students in their clinical practicums.

Bev is a well-known speaker in the Case Management field. Her publications include a chapter CMSA's Core Curriculum for Case Management Certification and most recently, co-author of the book, Core Skills for Hospital Case Management.

Bev has a BSN from Pittsburg State University, Pittsburg, Kansas and a Master of Science, Nursing Major, from the University of Oklahoma.  She is certified in case management (ACM) by the American Case Management Association.

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