Healthcare Utilization
Managing Limited Resources and Establishing Medical Necessity

  • 5-7 hours

    Learning time

  • Online

    Independent, self-paced learning

  • Practical Application

    Practical approach for immediate application

  • Comprehension Check

    Concluding quiz to ensure grasp of key concepts

    Essential Knowledge and Practical Understanding

    Learn the fundamentals of utilization management in healthcare, focusing on how resources are managed to balance cost, quality, and patient outcomes. Learners will explore medical necessity, Medicare coverage processes, levels of care, and strategies to reduce readmissions and control costs.

    Who It's For

    Ideal for administrators and clinicians alike who want to have a more practical understanding of the fundamentals of utilization management

    What You'll Learn

    • Define key concepts in utilization management, including medical necessity, coverage determinations (LCDs and NCDs), and levels of care.
    • Describe how healthcare resources are managed across inpatient, outpatient, and observation settings.
    • Summarize the impact of utilization management on cost control, readmissions, and patient outcomes.
    • Explain the role of data analytics and decision-making in improving efficiency and quality in healthcare delivery.

    Why It Matters

    Utilization management serves as a vital gatekeeper that optimizes the distribution of finite healthcare resources by ensuring every intervention is grounded in clinical medical necessity, thereby balancing high-quality patient outcomes with the long-term sustainability of the organization and system.
    Dr. Dalton M. Benson
    Subject Matter Expert

    Dr. Benson is an internal medicine specialist and Medical Director at Access Health Care Physicians with 30 years of experience within the managed healthcare industry. In addition to internal medicine, he has worked extensively in geriatrics and dementia, acting in Director and Chief roles, as well as an Assistant Professor of Geriatrics and Gerontology.

    Patrick Jones - Course author