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Reference: https://www.ahip.org/courses/medical-management-ahm540
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| Section | Weight | Objectives |
|---|---|---|
| Role of Medical Management | 20% | - Delegation and accountability - Overview in health insurance organizations - Regulatory and legal framework |
| Care Management Programs | 25% | - Preventive and self-care programs - Case management for complex patients - Disease management principles |
| Specialized Services | 15% | - Pharmacy benefit management - Telemedicine and virtual care - Behavioral health integration |
| Government Programs | 15% | - Medical management for Medicare - Compliance with federal regulations - Medical management for Medicaid |
| Utilization & Quality Management | 25% | - Accreditation standards (NCQA, CMS) - Quality measurement and improvement - Utilization review processes |
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