Last updated on Oct 12, 2024

What are the best sources of professional development or continuing education for Utilization Management?

Utilization management (UM) is a process of ensuring that health care services are appropriate, effective, and efficient for patients and providers. UM professionals need to keep up with the latest trends, regulations, and best practices in their field to deliver high-quality care and optimize outcomes. In this article, we will explore some of the best sources of professional development or continuing education for UM.

1 Online Courses and Webinars

One of the most convenient and accessible ways to learn new skills and knowledge in UM is to enroll in online courses and webinars. There are many reputable organizations and institutions that offer online learning opportunities for UM professionals, such as the American Case Management Association (ACMA), the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP), and the American Nurses Credentialing Center (ANCC). Online courses and webinars can cover a wide range of topics, such as UM standards, criteria, tools, strategies, ethics, legal issues, and more. Online courses and webinars can also provide continuing education credits (CEUs) or certification preparation for UM professionals.

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Tenaya Swann RN, C-DAM, CHFP

Director of Clinical Appeals at Discovery Behavioral Health
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Online webinars and courses are a great way to increase your knowledge and experience. It opens the door for opportunities to obtain certifications and break into utilization management. I specifically encourage taking online courses that are with a reputable, accredited institution. I also highly recommend taking courses through MCG’s Care Guideline certification program and InterQual’s Certified Expert program to become proficient in understanding level of care determinations and accurately applying medical necessity guidelines.

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2 Conferences and Events

Another way to enhance your professional development and continuing education in UM is to attend conferences and events that are relevant to your field. Conferences and events can provide you with the opportunity to network with other UM professionals, learn from experts and peers, and discover new innovations and solutions in UM. Some examples of conferences and events that are focused on UM are the ACMA National Conference, the ABQAURP Health Care Quality and Management Conference, and the Utilization Review Accreditation Commission (URAC) Summit. Conferences and events can also offer CEUs or certification renewal for UM professionals.

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Ronald Hirsch, MD, FACP, CHCQM, CHRI, ACPA-C

Vice President, Physician Advisory Solutions at R1 RCM, Advisory Board of American College of Physician Advisors and National Association of Healthcare Revenue Integrity, differentiator between acronyms and initialisms
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The National Physician Advisor Conference from American College of Physician Advisors is a great conference for physicians and UR staff alike. ACPA also sponsors regular webinars on UR topics at no cost.

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3 Journals and Publications

A third source of professional development and continuing education for UM is to read journals and publications that are related to UM. Journals and publications can provide you with the latest research, evidence, and insights in UM, as well as practical tips and case studies. Some examples of journals and publications that are relevant to UM are the Journal of Hospital Medicine, the Journal of Case Management, the Journal of Managed Care Medicine, and the Professional Case Management Journal. Journals and publications can also help you earn CEUs or certification maintenance for UM professionals.

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4 Mentoring and Coaching

A fourth source of professional development and continuing education for UM is to seek mentoring and coaching from experienced and qualified UM professionals. Mentoring and coaching can provide you with personalized guidance, feedback, and support in your UM career. Mentoring and coaching can help you improve your skills, knowledge, confidence, and performance in UM, as well as identify your strengths, weaknesses, goals, and opportunities. Mentoring and coaching can also help you prepare for certification exams or career advancement in UM.

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5 Professional Associations and Networks

A fifth source of professional development and continuing education for UM is to join professional associations and networks that are dedicated to UM. Professional associations and networks can provide you with access to resources, information, education, advocacy, and recognition in UM. Professional associations and networks can also help you connect with other UM professionals, share best practices, exchange ideas, and collaborate on projects. Some examples of professional associations and networks that are focused on UM are the ACMA, the ABQAURP, the Case Management Society of America (CMSA), and the National Association of Healthcare Access Management (NAHAM).

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Amanda Helminiak
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In my experience, ABQAURP membership gives professionals in UM the ability to network with peers, opportunities to increase fundamental knowledge in the field with relevant online educational courses, and a badge demonstrating legitimacy and commitment in the field through board certification.

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6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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Mathew Nembhard, RN, MBA

Healthcare professional/manage care
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Medicare help to drive changes in health care and health care utilization. It is a good practice to keep up with the Medicare learning Network MLN.

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What are the best sources of professional development or continuing education for Utilization Management?

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1 Online Courses and Webinars

2 Conferences and Events

3 Journals and Publications

4 Mentoring and Coaching

5 Professional Associations and Networks

6 Here’s what else to consider

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