Utilization Management

Masters Degree in Case Management

CSM 650

Breyer State University

Instructor:

Dennis C Collins, MSN, MBA, BSN

SYLLABUS

COURSE OVERVIEW: Welcome to UR, Quality Assurance, and Risk Management in Healthcare, a Masters Level course in the curriculum for the Degree, Masters in Case Management. I am pleased to instruct you in this course, in which we will explore Utilization Review, Case Management, and Risk Management principles.

You may ask “Why have these three areas been grouped into a single course?” The answer is that more and more healthcare originations are combining these three important functions within a single department. Persons seeking a position within these areas should be familiar with all of these practice areas, and understand how they relate to one another in the design of healthcare management systems.

I know you will enjoy this course. Please learn as much as you can as you progress through it, as it does lay down a solid foundation for the rest of the curriculum. It is my pleasure to have you in the course.

TIME FRAME: This is a five-semester hour course. This course is allotted ten weeks of time. You must complete all of the requirements for the course successfully by the end of the ten-week period. The first day of week one will begin the day that you register for the course, or the day which you notify me that your textbooks have arrived and you are ready to begin your studies. Please be cognizant of the time frame. It is rare that extensions of time are permitted, unless you have good justification. Upon successful completion of this course, you will be awarded five semester hours of credit.

TEXTBOOKS: There are two (2) required textbooks for this course.

Book 1: Risk Management in Health Care Institutions. Florence Kavaler, MD, MPH and Allen D. Spiegel, PhD, MPH. Jones and Bartlett Publishers, 40 Tall Pine Drive, Sudbury, MA, 01776:
Copyright 1997. ISBN # 0-7637-0257-9.
We will focus on chapters 1-7.

Book 2: Case Management - A Practical Guide to Success in Managed Care. Suzanne K. Powell. Lippincott: ISBN # 078171883x.
We will be studying chapters 1-9.

	» Click Here to Enter
» Additional Student Resources at StudyTactics

EXAMINATIONS: There are two examinations for this course, a mid-term exam and a final exam. The mid-term exam covers the material in the book, “Risk Management in Health Care Institutions”. The final exam covers the materials in selected chapters of the book “Advanced Case Management.”

The mid-term examination must be taken by the end of the fifth week in the course.
The final examination must be taken by the end of the tenth week in the course.

Both exams are programmed and are located in the classroom for this course. The examinations are “open book” objective type. You will have one (1) day to complete your exam, once you access it from the classroom. To access the exams, you must send me an email and request to have access to the exam. I will then program your access in. You will receive an email back from me telling you that you are now authorized to go ahead and to access your exam. To access, you will come into the classroom, click on testing, and click on the exam you are taking. You will need your User ID and PASS WORD to access the exam. The exam will appear on your screen. Once you access the exam, you have one day to submit your answers. The program provides me the exact date and time that you accessed the exam. The program also notifies me of the exact date and time that you submitted your answers. Thus, the program is timing you. When you are ready, go back into the classroom and click in your responses and then click submit. Shortly, you will receive the exam in your email box with your computed score. You will also know what questions, if any, that you missed, and what the correct answer is. I also receive a copy of your exam and your score.

GRADING: The grading scale for this course is as follows:

90-100%    = A
80-89%      = B
70-79%      = C
Below 70    = Fail

COMMUNICATION: You are encouraged to communicate with me. I am available as a teacher, coach, and mentor to assist you in meeting your goals for this course. Primarily, communication is through email. However, I am also available for conversation by telephone if you would like. Our classroom for this course has a “chat” room. I am also very willing to meet with you one-on-one in the chat room at your request. From time to time, depending on how many students are enrolled in this course at a particular time, we will have some scheduled group chats. You will receive more detailed information at the time such chat sessions are scheduled. If at any time during this course you change your email address; please be sure to notify me right away.

WRITTEN ASSIGNMENTS: There are no written assignments for this course. There is a considerable amount of reading involved in this course, and I would prefer you spend your time with the books learning the material.

ABOUT YOUR INSTRUCTOR: I am Dennis Collins RN, BSN, MBA, CM(c). I have over twenty years of full time nursing experience, and over ten years of health care management experience. I hold a degree in Masters in Business Administration, and a Bachelors’ Degree in nursing. I have certifications in both Emergency and Critical Care nursing, as well as in prehospital care. I am presently employed on a full time basis as a case manager for a large national firm. I also operate my own consulting business as a legal nurse consultant (LNC). I have background in both plaintiff and defense work. I have considerable health care CQI and risk management background. My work has been published in major health care journals.

COURSE OBJECTIVES: Upon completion of this course, you will be able to:

1). Understand the goals and objectives of the Risk Management process.
2). Understand the “red flags” in the concept of risk management.
3). Understand the rational and current practice of combining QA, RM, and UR functions.
4). Understand the HCFA concept of DRGs.
5). Understand the concept of NCQA HEDIS indicators.
6). Define benchmarking and understand its application.
7). Understand the concepts of TQM and CQI.
8). Understand Disease Management.
9). Understand the role of communications in risk reduction.
10). Understand the concepts of validity and reliability.
11). Understand process indicators and quality indicators and their applications.
12). Define numerator and denominator as they relate to quality assessment.
13). Understand the various types of charts and graphs and the ways that they can be utilized in the quality improvement process.
14). Understand the steps of the CQI process.
15). Understand the various types of CQI teams and their roles.
16). Understand decision making techniques for process improvement.
17). Understand root cause analysis.

INFORMATION: If you have any questions regarding this program, you may contact the instructor at dcoll90462@aol.com.

Apply	Pay Online	Refund Policy
Payment Plan	Email for Info	Register for a Course

ˆ Back To Top ˆ