Course Code: REL-PAY-0-ADBDM
Hours: 1.75
Type: Online Course
Content Expiration Date: 12/31/2025
Learning Objectives:
Discuss the background and implications of big data in healthcare.
Describe how data is utilized by case managers within different areas of the payer setting to improve care outcomes, measure case management performance, and identify fraud, waste, and abuse.
Explain how data drives better healthcare through evidence-based decision-making, application of medical necessity criteria, and utilization management.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: An Introduction to Healthcare Data
Testing Your Existing Knowledge
Overview of Healthcare Data
What is Big Data in Healthcare?
Review
Summary
Section 3: Data Sources
General Data Realms
Specific Data Sources
How Data is Used
Data Challenges
Needed Infrastructure
Potential Future Benefits
Review
Summary
Section 4: Data-Based Decision Making in the Payer Setting
Applying and Utilizing Data in the Payer Setting
Achieving Case Management Goals
Identification for Case Management Services
Critical Measurements During the Case Management Process
Case Management Performance Measures
Utilization Benchmarks and Best Practice Identification
Identifying Fraud, Waste, and Abuse
Data Measurements for Medical Necessity Adherence
Meet Jamal
Review
Summary
Section 5: Detailed Application of Data in Decision Making
Common Areas of Data Within Case Management
Outcome and Utilization Measures for Case Management
Medical Necessity Criteria
Clinical Pathways to Guide Decisions with Data
The Benefits of Data-Based Decision-Making
Review
Summary
Section 6: Conclusion
Course Summary
Course Contributors
Resources
References
Instructor: Wendy Waltrip, MSN, RN, CCM
Wendy Waltrip MSN, RN, CCM has a 23-year nursing career with experience in oncology, medical-surgical, acute rehabilitation, hospice, and nursing leadership. She has 10 years of deep working knowledge of case management with specific expertise in field and telephonic complex chronic condition case management and case management process optimization in managed care, acute, and community settings.
Writer: Alia Lutz, BA, BSN, RN
Alia Lutz, BA, BSN, RN, has over 10 years of experience as a Registered Nurse with a focus on cardiothoracic, respiratory, and coronary care. She has also had experience in Med-Surg, step-down and ICU. Prior to joining Relias as a SME and Content Writer for acute care, she provided virtual education and injection training on injectable biologics to patients, reported adverse events, and was a patient advocate. She has collaborated with peers on creating job aids, writing policies, and improving quality of care and documentation. Alia received her Bachelors in Nursing from Otago Polytechnic in New Zealand in 2011.
Target Audience:
The target audience for this course is: Care and Case Managers; Intermediate level Social Workers; Nursing Personnel; in the following settings: Hospitals: Acute.
Relias Learning will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Relias Learning has a grievance policy in place to facilitate reports of dissatisfaction. Relias Learning will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias Learning at support@reliaslearning.com.
All courses offered by Relias Learning, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.