Want to buy for someone else? You can purchase a token at check out.

This course is free with a membership upgrade!

Upgrade to a Standard membership and gain access to 1,000+ CE and professional development courses.

Overview
Goals and Outcomes
Details
Accreditations
Overview
Overview
The goal of this course is to equip nurses with knowledge of key principles of utilization management (UM) and responsibilities of the UM process.
Goals and Outcomes
Goals and Learning Outcomes
Utilization management (UM) and utilization review (UR) are often used interchangeably. UM is the umbrella practice for evidence-based, cost-effective care review. However, UR is a secondary, more focused branch that reviews billing aberrancies that are discovered by UM. UM began as a process for Medicare beneficiaries, but it has become a program for all insurance carriers and is present in all healthcare settings. UM and UR can either fall under one department or be separated based on organizational needs. 
 
The goal of this course is to equip nurses with knowledge of the purpose and key principles of utilization management (UM) in the acute care setting, as well as roles and responsibilities associated with the UM process.

After taking this course, you should be able to:

  • Identify the main concepts of utilization management and utilization review.
  • Discuss functions and tools of utilization management and utilization review.
  • Describe the role of nurses in utilization management and utilization review.

Course Termination Date: Not yet determined

Content Expiration Date: 12/31/25

Course Originally Released On: 08/01/22
Details
Course Details

Course Originally Released on : 8/1/2022

Course Expiration Date : 12/31/2025

REL-ACU-0-UMACRR

Course Author

Shalla Newton

MSN, RN, NE-BC

Cathryn Ayers

RN

Accreditations
Accreditations

NURSES
In support of improving patient care, Relias LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Provider approved by the California Board of Registered Nursing, CEP#13791

Accreditations imageAccreditations image

Disclaimer: Not all courses will provide California Board of Registered Nursing approval. Per California Assembly Bill No. 241, continuing education courses related to direct patient care shall address at least one or a combination of the following:(1) Examples of how implicit bias affects perceptions and treatment decisions of licensees, leading to disparities in health outcomes; or (2) Strategies to address how unintended biases in decision-making may contribute to health care disparities by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, or other characteristics.

CEBroker
Relias LLC reports to CEBroker for the following boards (Provider # 50-1489): Arkansas State Board Of Nursing, District Of Columbia Board Of Nursing, Florida Board Of Nursing, Georgia Board Of Nursing, New Mexico Board Of Nursing, South Carolina Board Of Nursing and West Virginia Board Of Examiners For Registered Professional Nurses
Please check the licenses/certifications section under my account (after logging in) to make sure you have entered a valid license number. This information is required for correct reporting of your course completions to CE Broker.

Disclosures
None of the planners/faculty, unless otherwise noted, for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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 1.00 CE contact hour(s).