Utilization Review

Building a Utilization Review Committee

Utilization Review is an essential part of a hospital's financial success and the first step is the development of a Utilization Review Committee.  Functional utilization review can give hospitals the ability to find inefficiencies and control costs, as well as identify areas to improve the quality of patient care.  Join Angie Mellen, Utilization Review Coordinator at Mineral Community Hospital as she walks through their journey of developing a successful Utilization Review Committee.

August 12: Building a Utilization Review Committee

• Webinar Recording
• Handout

Utilization Review Boot Camp Series

Utilization Review is a complex responsibility in all hospitals. The MT Flex Grant acknowledges this is an area of high education need for MT CAH staff. The Utilization Review Boot Camp series is designed to build UR skills from the ground up. The series, which was developed with the help of MT CAH staff, covers major topics surrounding utilization review, ending with a follow-up webinar for attendees to share UR practices and tips on developing a Utilization Review Committee.

April 16: Reducing Avoidable Readmissions and Documentation - Myrna Seno

• Webinar presentation
• Webinar recording
• Nursing: Readmission Alert Discharge Plan

April 23: Medical Necessity and Length of Stay - Rhonda Finstad

• Webinar presentation

Unfortunately the audio portion of the webinar did not record, so we will not be posting a webinar recording. Please refer to the presentation handout for details of the presentation. If you have need any clarifications on the content, please contact Rhonda Finstad at rfinstand@mtqio.sdps.org.

April 30: Insurance - Rachel Peura

• Webinar presentation
• Webinar recording

May 7: Mastering the Chaos - Attacking the 2 Midnight Rule - Day Egusquiza

• Webinar presentation
• Webinar recording
• Inpatient Certification Form

May 14: Utilization Review Committee and Hospital Sharing

• Call recording
• Call Notes
• Utilization Review Resources
• Facility Forms:
• CPMC Utilization Review Plan
• URInsuranceWorksheet_ProvidenceSJMC
• ConditionCode44_ProvidenceSJMC
• UMNotes_ProvidenceSJMC
• PatientReviewWorksheet_ProvidenceSJMC

Faculty: 
Myrna Seno, Care Transitions Project Lead, Mountain Pacific Quality Health
Rhonda Finstad, Director of Beneficiary Protection, Mountain Pacific Quality Health
Rachel Peura, Nurse Manager, Healthcare Management Division, Blue Cross Blue Shield
Day Egusquiza, AR Systems, Inc.