Case Management Boot Camp: Fundamentals in Utilization Management and Discharge Planning — Part III of III

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

Provided by MHA Health Institute
Health Institute

Date & Time

Tuesday, Feb. 12
12:30 - 2:30 p.m.

Register on or before Tuesday, Feb. 5, to ensure delivery of instructional materials.

MHA members — $225
Nonmembers — $275

The webinar registration fee is for one phone line connection. Each additional phone line connection will be charged a registration fee. Get more value by inviting colleagues to join you on the one connection.

This webinar is being offered at a reduced registration fee to MHA-member hospitals thanks to a generous contribution from the MHA Management Services Corporation.


Anyone involved with transitions in care including nurses, case managers, case management personnel, social work staff, post-acute care providers, physician advisors, finance directors, quality management and other interested personnel.

The following program content was provided by the speaker.


In this jam-packed webinar, attendees will learn how to streamline their utilization management process, as well as understand the Conditions of Participation for Utilization Review and how they impact their work as a case manager. The differences between utilization review and utilization management will be discussed. The process for incorporating medical necessity into the process of utilization management will be explained, as well as a review of compliance components for utilization review and incorporation of Condition Code 44 into the two-midnight rule. Other focus areas to be discussed will include the various types of Hospital-Issued Notices of Noncoverage and discharge planning as a fundamental role of case managers and social workers.


At the conclusion of this session, participants will be able to:

  • discuss how medical necessity is applied during a clinical review
  • implement the correct processes for Condition Code 44 and Provider Liable billing
  • discuss the different types of Hospital-Issued Notices of Noncoverage and when to use each type
  • explain how to apply utilization review to the two-midnight rule process
  • describe how compliance applies to the utilization management process
  • implement the basics of discharge planning to their role as a case manager or social worker
  • describe the strategies to be used for best practice discharge planning


Toni G. Cesta, Ph.D., R.N., FAAN
Founding Partner
Case Management Concept, LLC

Toni G. Cesta, Ph.D., R.N., FAAN is a founding partner of Case Management Concepts, LLC, a consulting company that assists institutions in designing, implementing and evaluating case management models in the acute care, emergency department and outpatient settings. Dr. Cesta writes a monthly column called "Case Management Insider" in the Hospital Case Management newsletter in which she shares insights and information on current issues and trends in case management.