The Utilization Management Committee: Strategies for coordinating Medical Practice with Hospital Goals
Instructor:
Bernadette Benta
Product ID: 706303
Training Level: Intermediate to Advanced
- Duration: 60 Min
Why Should You Attend:
The Utilization Review Committee is of great importance given the mandated status and functions it serves, roles and responsibilities and level of staff involved. However, some hospitals neglect to meet at regularly scheduled times or not at all.
This leaves then open to citations by Governmental and commercial payers actively engaged in monitoring hospitals adherence to UR requirements and the medical necessity of medical and surgical care.
Areas Covered in the Webinar:
- The Utilization Review Committee: creating one; the roles and responsibilities; selecting members.
- The Condition of Participation
- Who should be excluded?
- Physician Participation and Ownership
- Key Documentation
- Improving Engagement
- Outcomes and Content
Who Will Benefit:
- Physicians, Registered Nurses, Case Management Leaders, Hospital Administrators, Utilization Management Leaders
Bernadette Benta
Division Chief, Maryland Department of Health
Bernadette. A Benta, MSHA, BSN, RN is a Strategic Leader and Subject Matter Expert with twenty years of Operational experience in Care Management , Utilization Review and also works to develop Population Management programs.
She is a seasoned Consultant on both in Acute Care hospitals, Managed Care Organizations and serves as a Clinical Liaison of for Revenue Management programs. Ms. Benta possesses expert knowledge of Medicare and state-specific Medicaid knowledge, and does some does some SME work for the government. She has proven experience in building departments from the ground up and improving process in both payer and health system settings and identifying trends which impact service delivery for quality improvement and solutions to non-standard requests and problems. Seasoned Nationwide Healthcare consultant.
Topic Background:
The Conditions of participation: Utilization Review states the following:
The hospital must have in effect a utilization review (UR) plan that provides for review of services furnished by the institution and by members of the medical staff to patients entitled to benefits under the Medicare and Medicaid programs. The Utilization Review (URC) committee is the only committee required in the CoP.
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