Operations Excellence

Classroom

Care Management Conference

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How effective and successful is your care management program? Are you capturing the appropriate medical necessity for each patient who comes into your facility? Are you current on, and knowledgeable about, all regulatory and federal guidelines for care management? Do you understand managed care contracting? Or the role of care management in denial prevention and appeal management?

An effective care management (CM) system is critical to ensuring patients receive sufficient transitions of care assistance and securing the appropriate reimbursement for the services your facility provides. Our Care Management Conference will help you learn how to efficiently care for patients and secure appropriate reimbursement for your facility by applying best practices. Regardless of the type of services provided to the patient, it is necessary that your organization establishes consistent processes to secure payment while also transitioning patients through the care continuum at the appropriate time.

With the constant changes in the healthcare landscape, the CM department is key to driving successful results both clinically and financially. During this Care Management Conference, attendees will learn how to appropriately manage resources by ensuring sufficient care, at the right time, and at the most appropriate level. Conference topics will include medical necessity, discharge planning, gaps in care, physician escalation, UR committee structure and engagement, and contracting, among others.

Join QHR Health’s Care Management team for this intensive two- and half-day education event, designed to help develop your care management skills through topical, best-practice, and hands-on education. This program will help you improve your facility’s care management practice and provide you with an opportunity to network with peers.

Learning Objectives:

  • Design and implement effective and appropriate medical necessity and transitions of care processes that support efficient and timely patient care
  • Deploy leading strategies to appropriately manage length of stay and related gaps in care
  • Capture the necessary metrics and outcomes to monitor a care management program
  • Understand the importance clinical documentation has in your case management program
  • Recognize and deploy outlined processes for physician advisor escalation, multidisciplinary rounds, and denial management

Who Should Attend:

  • CNOs
  • Care Managers
  • Care Management Leadership
  • Social Workers
  • CFOs

Presenters

Day 1

8:00 am - 8:30 am | Live

Breakfast

Lynn Collins, headshot
8:30 am - 9:00 am | Live

Welcome and Introductions

Lynn Collins, Director, Clinical and Operational Improvement, QHR Health
Lynn Collins, headshot
9:00 am - 9:45 am | Live

Care Management Overview and History

Lynn Collins, Director, Clinical and Operational Improvement, QHR Health
Mayra Pineiro, headshot
9:45 am - 10:30 am | Live

Roles and Responsibilities

Mayra Pineiro, Senior Consultant, Clinical and Operational Improvement, QHR Health
10:30 am - 10:45 am | Live

Break

Dan Hobbs, headshot
10:45 am - 11:45 am | Live

Revenue Cycle Steering Committee: Build or Re-build

Dan Hobbs, Senior Consultant, Revenue Cycle, QHR Health
11:45 am - 12:45 pm | Live

Lunch

Lynn Collins, headshot
12:45 pm - 1:15 pm | Live

Payment Methodologies

Lynn Collins, Director, Clinical and Operational Improvement, QHR Health
Mayra Pineiro, headshot
1:15 pm - 2:30 pm | Live

Utilization Management

Mayra Pineiro, Senior Consultant, Clinical and Operational Improvement, QHR Health
2:30 pm - 2:45 pm | Live

Break

Wanda Wright, headshot
2:45 pm - 3:45 pm | Live

Managed Care

Wanda Wright, Associate Vice President, Managed Care, QHR Health
Lynn Collins, headshot
3:45 pm - 4:30 pm | Live

Clinical Cost Variation

Lynn Collins, Director, Clinical and Operational Improvement, QHR Health
4:30 pm - 4:45 pm | Live

Wrap Up

Lynn Collins, Director, Clinical and Operational Improvement, QHR Health
Mayra Pineiro, Senior Consultant, Clinical and Operational Improvement, QHR Health
Dan Hobbs, Senior Consultant, Revenue Cycle, QHR Health
Wanda Wright, Associate Vice President, Managed Care, QHR Health

Day 2

8:00 am - 8:30 am | Live

Breakfast

Mayra Pineiro, headshot
8:30 am - 10:00 am | Live

Discharge Planning

Mayra Pineiro, Senior Consultant, Clinical and Operational Improvement, QHR Health
10:00 am - 10:15 am | Live

Break

Lynn Collins, headshot
10:15 am - 11:00 am | Live

Care Coordination/Outlier Management

Lynn Collins, Director, Clinical and Operational Improvement, QHR Health
Mayra Pineiro, headshot
11:00 am - 12:00 pm | Live

Readmission Management

Mayra Pineiro, Senior Consultant, Clinical and Operational Improvement, QHR Health
12:00 pm - 1:00 pm | Live

Lunch

Lynn Collins, headshot
1:00 pm - 2:00 pm | Live

Population Health

Lynn Collins, Director, Clinical and Operational Improvement, QHR Health
2:00 pm - 2:15 pm | Live

Break

2:15 pm - 3:30 pm | Live

Case Studies

3:30 pm - 4:00 pm | Live

Wrap Up

Lynn Collins, Director, Clinical and Operational Improvement, QHR Health
Mayra Pineiro, Senior Consultant, Clinical and Operational Improvement, QHR Health
Wanda Wright, Associate Vice President, Managed Care, QHR Health
Dan Hobbs, Senior Consultant, Revenue Cycle, QHR Health

Day 3

8:00 am - 8:30 am | Live

Breakfast

Mayra Pineiro, headshot
8:30 am - 9:30 am | Live

Care Management Measurement and Reporting

Mayra Pineiro, Senior Consultant, Clinical and Operational Improvement, QHR Health
9:30 am - 9:45 am | Live

Break

Lynn Collins, headshot
9:45 am - 10:45 am | Live

Denial Management

Lynn Collins, Director, Clinical and Operational Improvement, QHR Health
Lynn Collins, headshot
10:45 am - 11:15 am | Live

What now?

Lynn Collins, Director, Clinical and Operational Improvement, QHR Health
11:15 am - 11:45 am | Live

Closing & Adjourn

Lynn Collins, Director, Clinical and Operational Improvement, QHR Health
Mayra Pineiro, Senior Consultant, Clinical and Operational Improvement, QHR Health
Wanda Wright, Associate Vice President, Managed Care, QHR Health
Dan Hobbs, Senior Consultant, Revenue Cycle, QHR Health

DISCLOSURES

Conflicts of Interest

A conflict of interest occurs when an individual has an opportunity to affect educational content about health care products or services of a commercial interest with which she/he has a financial relationship. No conflict of interest has been disclosed.

Commercial Support

No commercial support

Non-Endorsement of Products

Non-applicable

Off-label Product Use

Non-applicable

Accreditation Statement

The QHR Health Learning Institute is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Successful Completion of the Continuing Nursing Education Activity:

Registered participants who attend at least 85% of the program and complete the required course evaluations will earn up to 15.25 contact hours.

Note:  Certificates will be posted on the program website within one week of program completion.