ALL MEDICAL DIRECTOR 

Getting Started:  This course provides an overview of Care Delivery Organizations and high-level overview of Managed Care. 

Self-Learn Course:  Self-study courses to assist in Onboarding process. Only available to those with LearnSource access.

 

PRIOR AUTH MEDICAL DIRECTOR  (Learner can attend all topics if applicable. Applying Medicare Plan and Review Criteria will be trained once.)

Prior Auth Med Dir Workflow: This course provides an overview of the Prior Authorization Medical Director process in order to render a determination.

Applying Medicare Plan and Review Criteria:   This course focuses on the Medicare hierarchy plan and review criteria for prior auth and inpatient. including Medicare Inpatient Only list, NCDs, LCDs, LCAs, and locating UHC Medicare review guideline resources.

Prior Auth Med Dir MCG:  This course focuses on accessing and navigating the MCG Care Guidelines utilized during a Prior Authorization review.

Pre-Service IP Level of Care Review This course provides Level of Care (LOC) guidance and the tools required for a Pre-Service Elective Inpatient review.

PA Peer-to-Peer Process:  This course provides a review of the Prior Authorization Peer-to-Peer process including; when a change in determination is allowable, documentation for successful and unsuccessful attempts, phone etiquette tips and reminders.

PA Med Director Determination Documentation:  This course provides guidance and the tools necessary to adhere to Medicare's requirements while documenting a Prior Authorization review.

 

INPATIENT MEDICAL DIRECTOR (Learner can attend all topics if applicable. Applying Medicare Plan and Review Criteria will be trained once.)

Inpatient Med Dir Workflow:  This course provides an overview of the Inpatient Medical Director determination process including; medical, surgical, Acute Inpatient Rehabilitation (AIR), Long Term Acute Care (LTAC), and Skilled Nursing Facility (SNF).

Applying Medicare Plan and Review Criteria:   This course focuses on the Medicare hierarchy plan and review criteria for prior auth and inpatient. including Medicare Inpatient Only list, NCDs, LCDs, LCAs, and locating UHC Medicare review guideline resources.

Inpatient Med Dir MCG:  This course focuses on accessing and navigating the MCG Care Guidelines utilized during an Inpatient review.

Inpatient Level of Care/Length of Stay Review:  This course focuses on transitional level of care requests and reviews including; Skilled Nursing Facility, Acute Inpatient Rehabilitation; and Long-Term Acute Care.

Inpatient Peer-to-Peer Process:  This course provides a review of the Inpatient Peer-to-Peer process including; Peer-to-peer timeframes, when a change in determination is allowable, proper documentation.

Inpatient Med Director Determination Documentation: This course provides guidance and the tools necessary to adhere to Medicare's requirements while documenting an Inpatient review. [includes Notice of Denial of Medical Coverage (NDMC) and Notice of Medicare Non-Coverage (NOMNC)]

 

REFRESHER COURSES

Applying Medicare Plan and Review Criteria:   This refresher course focuses on the Medicare hierarchy plan and review criteria for prior auth and inpatient. including Medicare Inpatient Only list, NCDs, LCDs, LCAs, and locating UHC Medicare review guideline resources. 

PA Med Dir Workflow:  This refresher course provides an overview of the Prior Authorization Medical Director process in order to render a determination.

PA Med Dir MCG:  This refresher course focuses on accessing and navigating the MCG Care Guidelines utilized during a Prior Authorization review.

PA Peer-to-Peer Process:  This refresher course provides a review of the Prior Authorization Peer-to-Peer process including; when a change in determination is allowable, documentation for successful and unsuccessful attempts, phone etiquette tips and reminders.

Inpatient Med Dir MCG:  This refresher course focuses on accessing and navigating the MCG Care Guidelines utilized during an Inpatient review.