Best Practices in Case Management 2021 : Module 3 Recorded Webinar | Beverly Cunningham and Toni G Cesta | From: Feb 16, 2021 - To: Dec 31, 2021 |
Best Practices in Case Management 2021: Module 3 - Utilization Management: What Does it Really Mean for Case Management Professionals?
Utilization management was the first role applied in acute care case management models. It was first known as utilization review but has evolved into something much more comprehensive. Today it encompasses elements of resource management and denials management as well. This program will review the role of utilization management as it applies to today’s contemporary case management models. Included will be best-practice suggestions for your practice with tips and strategies for streamlining the process and making it as efficient as it can be. Required compliance for utilization management processes will also be addressed. Lastly, there will be a focus on incorporating the role of utilization management with the other roles of case management: resource management, discharge planning, and care coordination.
Session Outline:-
Learning Objectives:-
Why Should You Attend?
With the increased focus on the value of hospital case management, it is imperative that case management professionals understand not only the role of utilization management but how to integrate it with other case management roles and functions. Many hospitals are not able to provide a comprehensive didactic orientation program for their new staff. This program will provide that, as it relates to utilization management. This will also be a helpful review and update for seasoned case management staff.
Who Should Attend?
Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, new documentation systems, and other strategies for improving care and reducing cost. The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management.
Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.
Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement. Prior to her position as Senior Vice President at Lutheran Medical Center, Dr. Cesta has held positions as Corporate Vice President for Patient Flow Optimization at the North Shore – Long Island Jewish Health System and Director of Case Management, Saint Vincents Catholic Medical Centers of New York, in New York City and also designed and implemented a Master’s of Nursing in Case Management Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.
Dr. Cesta has been active in the research and development of case management for over 25 years. Her research in case management has included two funded studies measuring the effects of a case management model on congestive heart failure and fractured hip patient populations, with measures of patient satisfaction, quality of life, and short and long term clinical perceptions and outcomes.
Bev Cunningham, MS, RN, ACM is a founding partner of Case Management Concepts, LLC. She has a 25-year deep working knowledge of case management with specific expertise in denials management, the utilization management process, patient flow, and the role of the Case Manager and Social Worker in the Case Management process. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board.
She also co-authored the book Core Skills for Hospital Case Managers and wrote a chapter in most recent two editions of CMSA’s Core Curriculum for Case Management. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital, where she had responsibility for Case Management, Social Work, Health Information Management, Patient Access and Sold Organ Transplant services.
