Hospital Case Management Utilization Management: At the Bedside or Centralized?

Michael C Redmond

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What you'll learn?

  • Foundational roles of hospital case management
  • Utilization review versus utilization management
  • Medical necessity
  • Rules and regulations for utilization management
  • 2-Midnight Rule
  • Best-practice utilization management: The principal
  • Integrated model versus triad model of utilization management
  • Advantages and challenges of each model
  • Role collaboration for each model
  • Making your decision as a leader
  • Artificial Intelligence and utilization management
  • Utilization management’s future

Overview of the webinar

As hospital case management departments have evolved and matured, leaders are required to evaluate models and roles. Typically, all four roles of utilization management, care coordination, discharge planning and resource management have functioned at the bedside.  With the challenge of lack of candidates to fill all positions, as well as the challenge of payers and rules, requirements and regulations, hospital case management leaders are evaluating the appropriate place for utilization management to reside.  

There are challenges and advantages of each location for utilization management. As these decisions for hospital case management leaders have arisen, another entrance in the hospital case management realm has come in to being—Artificial Intelligence. 

As these critical decisions are being made, leaders must determine the appropriate location for utilization management in their facility, as well as the best method for performing utilization management. This requires strategy, planning, appropriate roles, collaboration and optimal outcomes. These will all be discussed in the webinar.

Who should attend?

  • Directors of Case Management 
  • RN Case Managers 
  • Social Work Case Managers 
  • Directors of Social Work 
  • Physician Advisors 
  • Chief Medical Officers 
  • Executives Responsible for Case Management

Why should you attend?

With the focus on accuracy and efficiency in hospital case management, all four case management roles are being examined. These roles include utilization management, care coordination, discharge planning and resource management. The role that has the most intense scrutiny is that of utilization management. This role can be quite challenging as payers, especially manager Medicare and managed Medicaid payers have varying rules and regulations. These rules and regulations can change frequently.  

As case management departments are challenged with ensuring all roles are filled and that all staff is working at the top of their license, both efficiently and compliantly, hospital case management leaders are evaluating the place where utilization management should reside—at the bedside……..or centralized?

This webinar will review both models of utilization management and give the attendee understanding of the pros and cons of each mode

Webinar Events
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Training CD-DVD

Physical CD-DVD of recorded session will be despatched after 72 hrs on completion of payment

Recorded video

Recorded video session

Speaker: Michael C Redmond, CEO and Lead Consultant, Redmond Worldwide

Dr. Michael C. Redmond, PhD, is a certified project manager, PMP, has two master certifications in business continuity/disaster recovery MBCP and FBCI and is certified in emergency management. She is active in cyber security and holds multiple ISO certifications (ISO/IEC 27001 Information Security Management, ISO/IEC 27032 Lead Cyber Security Manger, ISO/IEC 27035 Security Incident Response, ISO/IEC 22301 Business Continuity Management Systems, ISO/IEC 21500 Project Management, and ISO/IEC 41001 Environmental Management). She is an international consultant, speaker and published author.

Michael's MBA in Risk Management included courses in Information Security and Risk Management for Medical Devices and Healthcare. Michael is certified as a Senior Lead Manager in Information Security for Healthcare ISO 27999.As a practitioner, she has been implementing ISO 27999 and ISO 14971 for over 10 years for clients. 

Her past experience includes 13 years as a senior manager with Deloitte, KPMG and Chubb in the areas of: compliance, crisis management, business continuity, disaster recovery, emergency management, internal audit/ gap analysis. She was a business continuity/disaster recovery manager with the Bank of New York. She consults for clients in diverse industries such as banking, manufacturing, pharmaceutical, hospitals, government agencies, colleges and universities, law firms, and media.

Dr. Redmond spent 4 years on active duty with the army and 18 1/2 years as National Guard and Reserve before retiring as a major. She is a graduate of Command & General Staff College (Fort Leavenworth), attended civil affairs courses at the US Army JFK School of Special Warfare and is Hazmat trained and DOD certified. The White House honored Dr. Redmond at a luncheon as one of the Top Women in Her Field of Business Continuity.

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