Foundations of Utilization Review

Learning Objectives
List 3 requirements of EMTALA regulation
Identify 2 reportable diseases and the resource used to identify them.
Identify the importance the denial and appeal process.
Define the role and responsibilities of the physician advisor in utilization management
Assess the influence of changes and innovations in the healthcare delivery system on contemporary care management models.
• Recognize how advances in professional education shaped the healthcare delivery system.
Examine how payment models define care management models.
Define types of conservatorship
Describe the Anti-Kickback Statute
Explain a health care provider’s responsibility under the exclusion act