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Reference: https://www.ahip.org/courses/medical-management-ahm540
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| Section | Objectives |
|---|---|
| Topic 1: Introduction to Medical Management | - Role of medical management in health plans - Concepts and objectives of medical management |
| Topic 2: Care Management and Coordination | - Disease management programs - Case management principles - Transitions of care |
| Topic 3: Quality Management and Improvement | - Quality measurement and reporting - Performance improvement strategies |
| Topic 4: Regulatory and Ethical Considerations | - Compliance in medical management - Member rights and confidentiality |
| Topic 5: Utilization Management | - Preauthorization and precertification processes - Medical necessity review - Concurrent and retrospective review |
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