This course provides an overview of Utilization Management, including the role this team plays for MedStar ... show more

This course provides an overview of Utilization Management, including the role this team plays for MedStar Family Choice and key Utilization Management components and terms, an overview of benefits and resources available to members and network providers as it relates to Utilization Management and second opinions, specialist referrals, and fair hearings, and an overview of utilization rates and how MedStar Family Choice monitors utilization to inform strategic efforts and to prioritize member outcomes, reviewing over-utilization, under-utilization, and metrics and teams involved in monitoring utilization rates for the health plan.  It will also provide a review of the Utilization Management regulatory requirements and expected standards, including turnaround times for Maryland and DC.

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