Utilization Management Peer Reviewer Training Certificate Course

5.0 CME Credits

5.0 CE Credits

ABQAURP sub-specialty credits: Managed Care 5.0, Physician Advisor 5.0

Updated & Reviewed: New 2019 Utilization Management Peer Reviewer Training course. This course contains updated material. If you completed the previous version PRIOR to March 16, 2019, you may retake this course, claim continuing education credits, and receive an updated certificate.

Managed Care increased in popularity as third-party payors and government agencies became more concerned with rising healthcare costs. Hardly any area of healthcare is free from its impact. Historically, review of medical claims was the responsibility of corporate Medical Directors possibly reviewing cases outside their specialty area. Today, the standardization of utilization management activities by state regulations and utilization review accreditation organizations encourages the use of specialists in the service area under review.

Physicians' Review Network (PRN) has partnered with ABQAURP to provide physicians with an online certificate course in Utilization Management Peer Reviewer Training. The course will present the principles and procedures of Utilization Review and Utilization Management standards as required by URAC’s Health Utilization Management Accreditation and American Accreditation Health Care Commission under the Health Utilization Management Standards.

PRN is an Independent Medical Review Organization that has been URAC-Accredited as an Independent Review Organization since 2001.

This online certificate course will provide a detailed explanation of how health care professionals can keep medical decisions in the hands of qualified practitioners as peer reviewers.

At the conclusion of the activity, attendees will be able to:
  • Evaluate utilization review cases using the appropriate review process
  • Interpret utilization review terminology and concepts
  • Compare and contrast differences between the various types and levels of utilization review
  • Write clear and concise utilization review determination reports
  • Integrate clinical and medical reference material to create an appropriate determination rationale
  • Recognize applicable standards, as applied to utilization review activities
  • Apply utilization review process to improve personal clinical practice
  • Recognize the difference between internal and external reviews
  • Describe the external review process

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American Board of Quality Assurance and Utilization Review Physicians® (ABQAURP) and Physicians' Review Network (PRN). ABQAURP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

ABQAURP designates this enduring material for a maximum of 5.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABQAURP is an approved provider of continuing education for nurses. This activity is designated for 5.0 contact hours through the Florida Board of Nursing, Provider # 50-94.

This program is approved for Category 2 credit by the American Osteopathic Association.

  All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits. You have 60 days to complete the course after ordering. Please note: Exam candidates taking the Core Body of Knowledge and Diplomates renewing their certification may have less time to complete, as determined by deadlines imposed.

This activity is valid from March 16, 2019 through March 15, 2022.

Please read the ABQAURP Privacy Policy and we suggest strongly that you read the System Requirements before continuing.

COURSE FEES: Diplomate $170.00      Member $190.00      Non-Member $230.00

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About The Authors
Members of the CME Committee, Planners, and Faculty have disclosed to ABQAURP any relevant financial relationships. No relevant financial relationships or conflicts of interest exist in regard to the content of this activity.

Editorial Staff: The faculty and program planners are employees of Physicians' Review Network and have no conflicts of interest in regard to the content of this activity.

Linda G. Sheff, MBA, CHCQM

Linda G. Sheff, MBA, CHCQM is the President and Chief Executive Officer of Physicians' Review Network. She has held this position since 2010. Mrs. Sheff received a Bachelor of Sciences as a Medical Technologist in 1974 and a Masters of Business Administration degree from the State University of New York at Buffalo in 1981. She holds certification from the American Board of Quality Assurance and Utilization Review Physicians.

Mrs. Sheff has an extensive background in healthcare, medical reviews, and many years of managerial experience in laboratory services, information technology and hospital administration prior to concentrating on the utilization review industry in 1989.

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