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Learn five ways how utilization management (UM) can support employee wellness and engagement by promoting preventive care, reducing absenteeism, and enhancing…
Learn how to communicate clearly, timely, and respectfully with all stakeholders in utilization management (UM) using these tips and best practices.
Learn how to incorporate UM communication into your CQI process to improve health care quality and efficiency. Tips on goals, data, interventions, and evaluation.
Learn the key components of utilization management (UM), a process of delivering appropriate, efficient, and cost-effective health care services based on evidence.
Learn how to structure an appeal letter for a denied claim in utilization management. Follow these six steps to write an effective and persuasive letter.
Learn some best practices for writing an appeal letter that shows why the service or medication is medically necessary and appropriate for your patient.
Learn how UM certification can boost your career in health care utilization management. Discover the advantages of UM certification for credibility, growth…
Learn how to boost your career in utilization management by following these five steps to become a utilization management director from a utilization review nurse.
Learn about the most common UM tools and software for prior authorization, concurrent review, discharge planning, and case management.
Explore some of the best sources of professional development or continuing education for utilization management (UM) professionals.
Learn about the key performance indicators (KPIs) that can help you evaluate and improve your utilization management (UM) processes and outcomes.
Learn how to adjust your Utilization Management metrics for risk and case-mix factors to ensure fair and accurate comparisons and evaluations of your UM programs.
Learn how wellness incentives can impact your utilization management outcomes by reducing costs, improving quality, and enhancing coordination of care.
Learn how to adapt your Utilization Management skills to various scenarios and challenges in acute care, chronic care, behavioral health, managed care, and…
Learn how to conduct utilization review (UR) effectively and efficiently, based on the standards and guidelines of various professional associations and…
Learn about some of the key Utilization Management metrics that you monitor and report on a regular basis, and how they can help you improve your UM performance.
Learn how to ensure data quality and security when using Utilization Management databases with these best practices for data standards, security measures, quality…
Learn how joining a UM association or network can help you advance your career and skills in utilization management as a nurse.
Learn how to design and implement wellness incentives that align with your utilization management goals and strategies.
Learn the benefits and challenges of integrating utilization management with care coordination and transitions of care. Discover best practices to optimize your UM…
Learn about the best practices for Utilization Management (UM) in different settings and populations, such as acute care, ambulatory care, behavioral health, and…
Learn about the current trends and challenges in utilization management (UM) in different settings and populations, and how UM can improve quality and value in…
Learn how to incorporate patient feedback and satisfaction surveys into your utilization management (UM) processes to improve quality and outcomes.
Discover six ways that utilization management (UM) leverages digital tools and artificial intelligence (AI) to empower patients in their health care decisions and…
Learn how utilization management can measure and demonstrate its value and impact in value-based care using methods and metrics that reflect quality, efficiency…
Learn how to collaborate with other stakeholders in prior authorization denial and appeal scenarios, and improve your PA success rate.
Learn how to assess, seek, apply, practice, and update your skills and knowledge in clinical utilization review (CUR), a process of evaluating health care services.
Learn how to optimize your utilization management and clinical communication processes with different solutions such as EHRs, UMS, CCPs, AI, and telehealth.
Learn the key elements of a persuasive appeal letter that can influence the decision-maker and get approval for your utilization management request.
Learn how to use utilization management (UM) to improve quality, access, and cost of care for patients using the Triple Aim framework.
Learn how technology can help you enhance UM stakeholder engagement and satisfaction by automating workflows, improving communication, and fostering innovation.
Learn how UM can use predictive analytics to identify and manage high-risk patients and reduce readmissions. Discover the benefits and challenges of using data…
Learn the best practices for using AI tools to support UM, CDI, and coding processes, such as automation, data analysis, and outcome improvement.
Learn how to streamline prior authorization processes in utilization management by following these best practices for providers and insurers.
Learn how to use key indicators and outcomes to measure the value and benefit of prior authorization in utilization management, and how to improve it.