Leading Utilization Review Practices From Access To Exit

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Start Time:12:00 AM
End Time:12:00 AM
Contact Information
Additional Information

Provided by MHA Center for Education

Date & Location

Thursday, March 9, 2017

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Holiday Inn Executive Center
2200 Interstate 70 Dr. SW
Columbia, Mo.

Register on or before Thursday, February 23.

MHA-member — $299
Nonmember — $399

The registration fee includes continental breakfast, refreshments, lunch and program materials. This seminar is being offered at a reduced registration fee to MHA-member hospitals because of a contribution from MHA Management Services Corporation.


case management directors/managers, social services directors, care/case managers, utilization review staff, physician advisors, social workers, clinical documentation improvement specialists, access/registration staff, operating room/outpatient schedulers, transitional care staff, care coordinators, emergency department managers, directors of nursing, vice presidents of patient care services, admissions coordinators, revenue cycle leaders, business office/audit/appeal supervisors


The difference between utilization management and utilization review is not as subtle as you may think. Each plays an important function as the organization prepares for a value-based marketplace and new payment models. In many hospitals, the growing complexities governing utilization review has led to the creation of dedicated teams of utilization review specialists, and the rapidly changing marketplace has given hospital leaders new incentives to rethink the role of the case manager.

This program parallels the content of the recently published text, “The Hospital Guide to Contemporary Utilization Review,” and addresses the development of contemporary case management programs, which include a proactive utilization management perspective and robust utilization review program.


Upon completion of this program, participants will be able to:

  • explain the evolutionary trajectory of UR activities
  • distinguish utilization review from utilization management
  • describe the legal obligations of the hospital to comply with Chapter 42 CFR 482.30 of the Conditions of Participation
  • describe the impact that commercial payer contracts have on UR activities
  • explain the changes in the function and makeup of the UR committee
  • explain the meaning of medical necessity and the 2-midnight rule
  • describe how data and denial patterns can identify improvement opportunities


7:45 a.m. — Registration/Continental Breakfast

8:15 a.m. — Welcome and Objectives

8:30 a.m. — Issues and Terminology

9 a.m. — The Evolution of Utilization Review and Why We Do the Things We Do!

9:30 a.m. — The Utilization Team and its Partners

10 a.m. — Break

10:15 a.m. — Utilization Process: Pre-Admission

12:15 p.m. — Lunch (provided)

1 p.m. — Utilization Process: Concurrent

1:45 p.m. — Utilization Process: Post-Acute

2:30 p.m. — Break

2:45 p.m. — The Utilization Plan and the Utilization Management Committee

3:15 p.m. — Outcome Metrics

3:45 p.m. — Tools and Training

4:30 p.m. — Adjournment


Marianne McHale Ramey, R.N., ACM, CPUR
Vice President and Senior Partner
Phoenix Medical Management, Inc.
Pompano Beach, Fla.

Marianne McHale Ramey is a specialist in strategic plan development and program execution, and is recognized as a highly effective transformation project manager among her many clients. She has served as interim director/project manager of care management and utilization review at several hospitals.

McHale Ramey has authored several articles on hospital case management and is the co-author of the popular book “The Leader’s Guide to Hospital Case Management.”

Continuing Education

Participants must attend the program in its entirety and complete an evaluation to receive a certificate of attendance and continuing education credits.

Case Managers — 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 6.5 contact hours. Activity code: S00019728. Approval number: 160000520.

All Other Participants — A certificate of attendance for 6.5 clock hours will be awarded.