Medical Management

Course Overview

Over the last several years, landmark reports have brought attention to the gaps between evidence-based best practices and the care some patients actually receive. However, when health care organizations adopt medical management tools, the gap closes. As care improves, costs go down. The Medical Management (AHM540) online course provides the information tools you need to ensure that more consumers and patients receive safe, effective, affordable care.

Learning Objectives

What You’ll Learn

  • Understand the role of medical management in health insurance provider organizations
  • Identify how and why a delegation is used in medical management
  • Examine the role of medical management in providing pharmacy services
  • Recognize the importance of preventive care and self-care programs
  • Explore strategies for managing complex individual cases
  • Understand disease management—its purpose, processes, and programs
  • Learn how medical management is used in different types of care
  • Quality management methods—measurement and improvements
  • Recognize how medical management is used to deliver Medicare and Medicaid services

Who Should Take This Course

  • Case managers
  • Government benefit programs administrators
  • Health insurance provider staff
  • Medical directors
  • Medical management staff
  • Pharmacy benefit manager staff

Module 1: Medical Management in Health Plans

Module 2: Quality Part 1 (Healthcare Quality and Quality Management)

Module 3: Quality Part 2 (Quality Assessment and Measurement)

Module 4: Quality Part 3 (The Performance Measurement System)

Module 5: Quality Part 4 (Reporting and Challenges in Measurement)

Module 6: Utilization Review Part 1 (How UR Works)

Module 7: Utilization Review Part 2 (Appeals, Regulation and Accreditation, & Other Issues)

Module 8: Case Management Part 1 (What It Is and How It Works)

Module 9: Case Management Part 2 (Issues in Case Management)

Module 10: Disease Management

Module 11: Acute Care Part 1 (Inpatient and Emergency Care)

Module 12: Acute Care Part 2 (Clinical Pathways and Centers of Excellence)

Module 13: Post-Acute Care

Module 14: Preventive Care and Wellness

Module 15: Pharmacy Benefit Management Part 1 (Formularies & Pricing)

Module 16: Pharmacy Benefit Management Part 2 (Medical Management Approaches)

Module 17: Specialty Services

Module 18: Medicare

Module 19: Medicaid

Module 20: Course Summary

Price: $435

This Course includes:

   Text-based content

   6 weeks