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Course Outline:
Week 1: One-hour class reviewing the History of utilization review and conditions of participation requirements for utilization review.
Week 2: One-hour class Understanding utilization review processes, case scenario presented to discuss appropriate level of care designation.
Week 3: One-hour class reviewing required CMS notices. Case scenario presented to discuss appropriate level of care and appropriate notices to be provided.
Week 4: One-hour class discussing advance utilization review practices. Review of case scenarios on tracking avoidable days and understanding utilization review and hospital metrics such as case mix index and length of stay.
About Us
TIFFANY FERGUSON, LMSW, CMAC, ACM
CEO of Phoenix Medical Management, Inc.
Tiffany serves as an adjunct professor at Northern Arizona University, Department of Social Work, and on the American College of Physician Advisors (ACPA) Observation Committee. Tiffany is co-author of The Hospital Guide to Contemporary Case Management through HcPro. She is a contributor for RACmonitor and Case Management Monthly; she also serves on the editorial board for CMSAToday and Care Management. She is a weekly correspondent on SDoH for the news podcast Talk Ten Tuesday. After practicing as a hospital social worker, she went on to serve as Director of Case Management and quickly assumed responsibilities in system level leadership roles in Health & Care Management, which includes CM, UR, CDI, HIM, and coding. She has held C-level responsibility for a large employed medical group which included value-based arrangements and outpatient care management. Tiffany is a graduate of Northern Arizona University and received her MSW at UCLA.
SARA WILLIAMS, MSN, RN, ACM-RN
Vice President of Clinical Strategy
Sara Williams has over 35 years of healthcare and since 2009, has been dedicated to the advancement of case management in the acute inpatient and ambulatory care management settings. She was instrumental in the development of an integrated case management/population health model that addressed care across the continuum for a major health system and served as a System Director of Case Management for a large health system, where she led the implementation of a standardized care management model for all acute care facilities within the system. Sara has extensive experience in leadership, case management, and utilization review. She recently implemented a system-wide program to incorporate pre-claim denial management strategies into the utilization review process. This process included collaboration with Revenue Cycle, Contracting, and Physician Advisor partners, to ensure appropriate reimbursement for services provided to patients. Sara holds a Master’s degree in Nursing with a concentration in Leadership & Management and is certified in Case Management with the American Case Management Association.
About the Course
This is a comprehensive foundational course on the history of utilization review and the basics of how to excel in your role as a UR Specialist. The target audience is any RN in the field of UR or interested in UR. This course will be a cohort class 1 hour per week for 4 weeks.
Who Is This For
Case Managers, Utilization Review Specialists, Directors and Managers that oversee Case Management programs, and anyone who wishes to have a better understanding of the case management role and program
Explain the four parts of Medicare and coverage by each entity that affects patient care, placement and copays.
Extend enhanced knowledge of advance required Medicare notices to deliver these to patients at the optimal time during their stay.
Describe three techniques used to improve communication and relationships with team members to create a successful UR process.
Registration Info:
The cost for this virtual workshop course is $250, which includes a certificate. Register online at https://www.phoenixmed.net/education. Please contact [email protected] if you have any questions, concerns or need special accommodations. Registration closes 3 days before class begins. Cancellations must be received 2 weeks prior to the end of the course completion and a refund will be issued for the course.
Refund/Cancellation Policy in the event of Non-Attendance:
A full refund will be issued if requested up to 2 weeks before class starts, a payment credit can be used to reschedule the class for a future date. CE contact hours will only be credited for full course attendance and completion. “Phoenix Medical Management has been approved by the California Board of Registered Nursing, Provider #17829, for 4.0 Contact Hours.” *“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 4.0 contact hours.