Utilization Management

Masters Degree in Case Management

CSM 650

Breyer State University

Instructor:

Dennis C Collins, MSN, MBA, BSN

SYLLABUS

COURSE OVERVIEW: Welcome to the Health Care Utilization Review course, CSM 650.  

This is a basic course that is designed to introduce you to the essential concepts of health care utilization management, health care risk management, and to some of the organizational concepts and dynamics related to this area.

This course is designed for health professionals (RNs, Social Service Staff, etc.) who are seeking additional background to aid in their transition from a clinical to a case managerial/risk management role. 
I know you will enjoy this course. While you progress through the course and read the required texts, please feel free to email me with any questions about the material at any time.

TIME FRAME: This is a 4-semester hour course. This course is allotted 15 weeks of time. You must complete all of the requirements for the course successfully by the end of the 15-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 4 semester hours of credit.

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

Book 1: Case Management, A Practical Guide to Success in Managed Care. Suzanne K. Powell.  ISBN: 0-7817-1883-x.  2000, Lippincott Williams and Wilkins Publishers.

Book 2:  Risk Management in Healthcare Institutions, A Strategic Approach. Florence Kavaler, Allen Spiegel,  ISBN: 0-7637-0257-9, Jones and Barlett Publishers

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EXAMINATIONS: There are two examinations for this course, a mid-term exam that must be taken by the end of the 8th week in the course and a final exam that must be taken at the end of the 15th week in the course. Both tests are based on the assigned material.

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. Please keep my email address handy so that you can contact me at DCOLL90462@aol.com 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 functions of workers in the health care setting in case management, risk management, and quality assurance.
2). Understand the various types of case management strategies as they apply to acute care, work related injuries, third party payers, home, and skilled settings.
3). Understand health care related financial concepts, such as avoided costs and hard savings.
4). Understand the role of health care accrediting agencies.
5). Understand the health care environment related concerns that apply to employment law, compensation, and the Americans with Disabilities Act (ADA).
6). Review essential leadership and organizational skills needed by an individual in the case management role.
7). Understand the importance of client/consumer communications as a strategy to reduce risk.
8). Understand general health care related risk management strategies.
9). Understand how organization dynamics influence the case management process.
10). Have an understanding of quality indicators in the health care setting.
11). Understand legal issues in case management.
12). Review common ethical issues in health care and case management.

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

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