Leading Utilization Review Practices From Access to Exit

Contact Our Team


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

Provided by MHA Health Institute
MHA Health Institute Logo

Date & Location

Tuesday, March 5

Missouri Hospital Association
4712 Country Club Drive
Jefferson City

Register on or before Tuesday, Feb. 26.

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 thanks to a generous contribution from MHA Management Services Corporation. This seminar also is eligible for use of the MHA Health Institute coupon. Coupons were mailed to MHA-member hospital CEOs on Dec. 17.

Hotel Reservation

Hampton Inn
4800 Country Club Dr.
Jefferson City

Request the MHA Health Institute overnight room rate:

  • $109 + tax for double beds
  • $114 + tax for a king bed


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 rapidly changing marketplace has given hospital leaders new incentives to rethink the scope of the case management program and the role of the case manager as the care coordinator for high-risk/high-utilizing patients. Concurrently, the expanding complexities governing utilization review activities has led to the creation of dedicated teams of utilization review specialists with broad knowledge of regulatory requirements and contractual obligations to ensure that hospital resources are being used appropriately from access to exit.


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

  • explain the evolutionary trajectory of utilization review 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 utilization review activities
  • explain the changes in the function and makeup of the utilization review committee
  • describe how data and denial patterns can identify improvement opportunities


7:30 a.m. — Registration/Continental Breakfast

8 a.m. — Welcome and Objectives

8:30 a.m. — Issues and Terminology

8:45 a.m. — The Evolution of Utilization Review and Why We Do the Things We Do

9:15 a.m. — Utilization Review and its Payers

9:45 a.m. — Break

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

10:45 a.m. — Utilization Process: Admission

11:45 a.m. — Lunch (provided)

12:30 p.m. — Utilization Process: Concurrent

1:15 p.m. — Utilization Process: Post-Acute

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

2:30 p.m. — Break

2:45 p.m. — Outcome Metrics

3:15 p.m. — Tools and Training

4 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.