The All UM Nursing Roles Assessment includes questions from the following modules:
• Introduction to Utilization Management
• Working Together – Utilization Management Team
• Utilization Management Resources for Members and Providers
• Standards for Outbound Provider Communications and Outreach
• Communication Log
• Over- and Under- Utilization
• Referrals to Case Management
• Identifying Quality of Care Concerns and referrals to Quality Department
• Reviewing Authorization Requests
• UM Decisions and Timeline Requirements
• Identifying when Medical Director Review is Required
• Insufficient Information Extension Workflows
• Decision Letters that Meet Expectations and Requirements
• Receiving and Processing Peer to Peer Requests
show less
