American Board of Quality Assurance and Utilization Review Physicians

5 CME Credits

5 CE Credits

New 2012 Utilization Management Peer Reviewer Training course. This course contains updated material. You may retake this course and claim continuing education credit(s).

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.

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

Topics include:
  • Current regulatory requirements
  • Key concepts
  • Crafting a quality report
  • URAC standards

  • It is in every clinicians best interest to become familiar with the principles of utilization review (UR), incorporate those principles into private practice, and become involved in UR activities whenever possible. Patient interests are best served through utilization reviews performed by licensed clinicians in active practice who are dedicated to preserving quality medical care.

    After completing this program and successfully passing the final evaluation, you will be well prepared to play a critical role in the innovative healthcare delivery partnerships available in the managed care arena. The knowledge you gain as a peer reviewer will also benefit your clinical practice and improve documentation for your patients. By applying your expertise, in cooperation with other licensed professionals, you will collaborate in accomplishing the goal of utilization management: to maximize the health and well being of each individual patient.

    This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Board of Quality Assurance and Utilization Review Physicians, Inc. (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 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

    The American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is an approved provider with the Florida Board of Nursing to provide continuing education for nurses. ABQAURP designates this activity for 5 contact hours through the Florida Board of Nursing. Provider # 50-94.

    All participants must achieve a post-test score of at least seventy percent (70%) for continuing education credits. This activity is valid from August 1, 2012 through August 31, 2014.

    Editorial Staff: The faculty and program planners are employees of Physicians' Review Network and have no other conflicts of interest with the content of this education.


      Course Description & Objectives
    • 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.

    CME 5 CEU 5
    Linda G. Sheff, M.B.A., CHCQM (Click this link for author bio)
    Ms. Sheff has indicated no relevant financial relationships to disclose in regard to the content of this activity.

    Course Fees:
    DIPLOMATE $170.00      MEMBER $190.00      NON-MEMBER $230.00

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    American Board of Quality Assurance and Utilization Review Physicians
    6640 Congress St. - New Port Richey, FL, 34653
    Toll Free - 800.998.6030 - Telephone - 727.569.0190
    Fax - 727.569.0195
    © ABQAURP - 2014