Medical Management (AHM540)



Explore medical policy and technology evaluation, appropriateness of care issues, authorization systems, and clinical practice guidelines. With this course, you’ll discover focused strategies for utilization management, including clinical paths and disease management. Quality management (QM) methods and strategies are also described. You’ll also learn about accreditation, quality improvement studies, benchmarking, performance measurement, and legal aspects of QM are addressed, as well as QM strategies for different clinical settings.

What You’ll Learn

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

Who Should Take This Course

  • Employees who work for health care providers or health insurance plans and want to acquire the educational background to pursue a management position in the industry
  • Case managers and medical directors who seek a broader administrative background
  • Educators at the college level who teach health care administration
    Financial planners, and agents and brokers who specialize in life and health insurance
  • Medical management staff working in hospitals, outpatient health systems, and health insurance plans
  • Employees of pharmacy benefit managers (PBMs) and those charged with oversight of pharmacy benefits
  • Administrators of government benefit programs
  • Consumers and others in related fields who seek expertise in this area


  • $220 AHIP Members
  • $280 Non-members

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Earn a Designation

This course is good towards earning the following Academy for Healthcare Management designation:

Fellow, Academy for Healthcare Management (FAHM®)

Sponsored by America’s Health Insurance Plans and the Blue Cross Blue Shield Association, AHM relies on both associations’ decades of experience providing continuing education for health insurance plan professionals. AHM serves more than 1,300 health insurance plans caring for and providing coverage to more than 200 million people.

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