Utilization Management

Utilization Management (UM) is a critical process in healthcare administration that involves evaluating the appropriateness and medical necessity of health care services, procedures, and facilities according to evidence-based criteria or guidelines. Coursera's Utilization Management catalogue teaches you the fundamental principles of managed care techniques, including prior authorization, case-by-case assessments, and the use of evidence-based criteria to guide decision-making in healthcare delivery. You'll learn to analyze medical appropriateness, implement UM policies and processes, apply UM criteria frameworks, and conduct prospective, concurrent, and retrospective reviews for cost-effective healthcare management. Mastering Utilization Management empowers healthcare professionals to optimize resource allocation, improve patient outcomes, and navigate the complex landscape of healthcare cost management, making it an essential skill for those working in insurance, healthcare administration, and clinical settings.
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Results for "utilization management"

  • Status: Free Trial

    Skills you'll gain: Value-Based Care, Medical Management, Preventative Care, Care Management, Practice Management, Public Health and Disease Prevention, Case Management, Utilization Management, Interoperability, Primary Care, Health Informatics, Patient-centered Care, Chronic Diseases, Public Health, Electronic Medical Record, Data Management, Health Education

  • Status: New
    Status: Free Trial

    Skills you'll gain: Denial Management, Claims Processing, Medical Billing and Coding, Medical Billing, Insurance Policies, Utilization Management, Billing & Invoicing, Insurance, Medicare, Revenue Cycle Management, Medicaid, Healthcare Industry Knowledge, Regulatory Compliance

  • Status: New
    Status: Free Trial

    Skills you'll gain: Medical Billing, Denial Management, ICD Coding (ICD-9/ICD-10), Patient Registration, Billing, Medical Billing and Coding, Medical Coding, CPT Coding, Accounts Receivable, Payment Processing and Collection, Medical Office Procedures, Utilization Management, Medical Records, Billing & Invoicing, Insurance, Medicare, Health Insurance Portability And Accountability Act (HIPAA) Compliance, Health Systems, Healthcare Industry Knowledge, Regulatory Compliance

  • Status: Preview

    Skills you'll gain: Infection Control, Pharmacology, Hand Hygiene, Medical Prescription, Public Health and Disease Prevention, Medication Administration, Infectious Diseases, Utilization Management, Diagnostic Tests, Microbiology, Pulmonology, Urology, Treatment Planning, Clinical Practices, Clinical Assessment

  • Status: Preview

    Skills you'll gain: Managed Care, Health Policy, Health Systems, Medicare, Healthcare Industry Knowledge, Medicaid, Utilization Management, Health Administration, Care Management, Health Care, Governance, Pharmaceuticals, Case Studies

What brings you to Coursera today?

    What brings you to Coursera today?

    Leading partners

    • AAPC
    • Universidad Nacional de Colombia
    • University of Houston
    • University of Pennsylvania