Date & Time: 06/04/2016 at 12:00 p.m. ET

The session will examine the evolution of utilization management (UM) programs and related medical management functions over the past three decades with a detailed overview of how UM programs are regulated and operationalized today. The speakers will highlight the impact of recent regulatory reforms on the ways that health plans make “medical necessity” and “scope of coverage” determinations, and how the appeals process works when a “denial” of care or adverse benefit determination is made. In addition, the presentation will review the scope, licensure, reviewer qualifications and other UM regulatory requirements.  The session will also examine liability issues associated with the “corporate practice of medicine”. Finally, the session will address how UM and care management programs are currently deployed to support integration, workflow efficiencies and improved clinical outcomes.  To register, click here.  

Speakers:

• Julie O’Brien, BSN, RN, MS, President, AliCare Medical Management
• Garry Carneal, JD, MA, co-Founder, RegQuest and Former President & CEO, URAC
• Catie Spivey, JD, Senior Legal Counsel, RegQuest (Session Moderator)