Course Provider
Learning Objectives
Understand and apply Medicaid rules and regulations to manage patient care effectively.
Differentiate between VA insurance and other insurance types, understanding their specific UM requirements.
Distinguish between primary and secondary insurance in UR and apply this knowledge in decision-making.
Identify the specific UM requirements for specialty areas like maternity, NICU, behavioral health, and surgeries.
Utilize EMRs effectively to understand patient status and classification, including OPIB statuses.
Evaluate the appropriateness of social admissions and understand how administrative days are managed and reviewed.
Demonstrate the ability to apply administrative oversight in understanding and managing Key Performance Indicators (KPIs) in Utilization Review.