AHIP Medical Management : AHM-540

  • Exam Code: AHM-540
  • Exam Name: Medical Management
  • Updated: Aug 18, 2026     Q & A: 163 Questions and Answers

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About AHIP AHM-540 Exam

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AHM-540 Exam topics

Candidates must know the exam topics before they start of preparation. Because it will really help them in hitting the core. Our AHM-540 exam dumps will include the following topics:

  • The role of medical management in a health plan
  • How and why a delegation is used in medical management
  • How medical management is used to deliver Medicare and Medicaid services
  • Strategies for managing complex individual cases
  • How medical management is used in different types of care
  • Disease management-its purpose, processes, and programs
  • The role of medical management in providing pharmacy services
  • Quality management methods-measurement and improvement
  • The importance of preventive care and self-care programs

Reference: https://www.ahip.org/courses/medical-management-ahm540

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How to book the AHM-540 Exam

These are following steps for registering the AHM-540 exam. Step 1: Visit to AHIP Exam Registration Step 2: Signup/Login to AHIP INSURANCE EDUCATION account Step 3: Search for AHM-540 Exam Certifications Exam Step 4: Select Date, time and confirm with payment method

What is the duration of the AHM-540 Exam

  • Format: Multiple choices, multiple answers
  • Number of Questions: 163
  • Length of Examination: 120 minutes

AHIP AHM-540 Exam Syllabus Topics:

SectionObjectives
Topic 1: The Medical Management Function- Role of medical management
  • 1. Medical management committees
    • 2. Responsibilities of the medical director
      • 3. Delegation and subdelegation of medical management functions
        • 4. Goals and components of medical management programs
          - Environmental influences on medical management
          • 1. Accreditation organizations and standards
            • 2. Impact of environmental factors on delegation
              • 3. Federal and state regulatory requirements
                • 4. Purchaser, provider, and member expectations
                  - Relationship of medical management to other health plan functions
                  • 1. Sales and marketing
                    • 2. Legal affairs
                      • 3. Finance
                        • 4. Claims administration
                          • 5. Risk management
                            • 6. Network management
                              • 7. Information management and technology
                                Topic 2: Medical Management Across Care Settings- Medical management for pharmacy services
                                • 1. Specialty services management
                                  • 2. Pharmacy benefit management
                                    - Medical management for acute care
                                    • 1. Acute care strategies
                                      • 2. Post-acute care management
                                        - Medical management for government-sponsored programs
                                        • 1. Medicare
                                          • 2. Other government-sponsored programs
                                            • 3. Medicaid
                                              Topic 3: Preventive and Care Management Programs- Utilization management
                                              • 1. Authorization and utilization review processes
                                                • 2. Medical necessity review
                                                  - Preventive care and self-care programs
                                                  • 1. Health promotion initiatives
                                                    • 2. Member education and wellness
                                                      - Case management
                                                      • 1. Care coordination
                                                        • 2. Management of complex cases
                                                          - Disease management
                                                          • 1. Population health management
                                                            • 2. Chronic disease programs
                                                              Topic 4: Clinical Practice and Quality Management- Quality management
                                                              • 1. Performance measurement
                                                                • 2. Quality assessment
                                                                  • 3. Quality improvement methodologies
                                                                    - Clinical practice management
                                                                    • 1. Medical policies and practice parameters
                                                                      • 2. Evidence-based clinical guidelines

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