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AHM Medical Management AHM-540 Exam is designed by the Academy of Health Care Administration (AHM) and sponsored by the US Health Insurance Plans and the Blue Cross Blue Shield Association. AHM is a self-study examination based program. AHM-540 Exam validates candidate has knowledge about the medical policy and technology evaluation, appropriateness of care issues, authorization systems, and clinical practice guidelines. This exam also verifies the candidate has the ability to discover focused strategies for utilization management, such as clinical paths and disease management. This exam also evaluates the candidate proficiency in accreditation, quality improvement, benchmarking, performance measurement, and legal aspects of QM, as well as QM strategies for different clinical settings.
Reference: https://www.ahip.org/courses/medical-management-ahm540
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| Section | Objectives |
|---|---|
| Introduction to Medical Management | - Role of medical management in health plans - Concepts and objectives of medical management |
| Regulatory and Ethical Considerations | - Compliance in medical management - Member rights and confidentiality |
| Care Management and Coordination | - Transitions of care - Disease management programs - Case management principles |
| Utilization Management | - Preauthorization and precertification processes - Concurrent and retrospective review - Medical necessity review |
| Quality Management and Improvement | - Performance improvement strategies - Quality measurement and reporting |
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