Care Excellence for Hospitals   

The social surroundings of an individual not only contribute to health outcomes, but they are major influences on an individual’s health and well-being. In this course, you will learn what elements in a patient’s daily life affect their health; define health literacy and its impact on social determinants of health; list strategies and best practices for interacting with patients and refining resource management; and more.

Care managers provide crucial services to ensure effective care delivery and efficient resource utilization. This course explores care management functions that underpin hospital operations, describes why they are important, and delivers innovative strategies in how to execute them efficiently and effectively.

Participants completing this module will learn about the common causes of dementia, the early warning signs, and the typical progression of symptoms, as well as the pathology of Alzheimer’s disease, and its significant impact on individuals, families, and communities. The module explores the challenges of early and accurate diagnosis and delivers evidence-based tools for screening and assessment.

Literacy and health literacy are imperative for effective person-centered care, but they’re often misunderstood or difficult to accurately assess. This module examines four types and measurements of literacy and related skills; helps learners distinguish between “general literacy” from “health literacy”; explains how health literacy impacts patient outcomes, health experiences, and health costs; shows how to identify who may be at risk; and delivers proven strategies for improving health literacy.

This module examines the importance of collecting metrics; metric tracking for compliance, quality improvement, satisfaction, cost, and productivity; understanding the relationship between data and strategic planning; and how to formulate strategic plans based on data.

This module brings into focus regulations and laws that impact healthcare organizations, and the processes care managers can use to comply with the regulations while assuring delivery of appropriate and needed care. The curriculum covers tools and resources for managing initiatives related to regulations.

Healthcare outcomes today are not measured within working silos (such as hospitals, provider practices, and post-acute services) but along the axis of care. This course will equip learners to discuss the need for community partnerships to ensure patient care and successful recovery and self-management; identify opportunities to engage community workers in developing realistic and sustainable care plans; and discover where to access information about community agencies that serve diverse patient needs.

Explore principles for maintaining healthy relationships with patients and members of the care team. Increase your understanding of the care manager’s role with protected and vulnerable populations; patient rights and informed consent; and best practice interventions that positively modify patient behaviors.

Concepts of Care Management provides the historical evolution of care management leading to modern best practices for assessment, patient engagement, planning, and coordination of care and services across the healthcare continuum. You’ll learn to identify patients who may benefit from care management interventions; evaluate best practices for proactive care planning; and formulate professional definitions of care management interventions used in diverse healthcare settings.

Hospital care managers must be experts at addressing crisis situations, ranging from those that involve specific patients and families, to large-scale emergencies and crisis scenarios common in healthcare environments. This course delivers effective approaches for defusing and managing high-stress situations between patients and providers, or between team members. It also provides clear interventions and communication strategies that care managers can employ during natural disasters and other emergencies.

Care managers are tasked not only with guiding patients through life-changing medical crises, but also ensuring continuum of care by linking them to needed community resources and preparing them for next steps in disease progression. This course identifies nine cornerstone care management concepts that are critical in addressing patient crises; common crises scenarios in inpatient settings; and evidence-based responses to each scenario

This curriculum delivers practical strategies that care managers can use to assist patients in crisis situations such as a major health crisis, harm to self or others, aggression and violence, and natural or other disasters. Having these effective strategies in hand allows care managers to best support others in coping with grave and emergent events.

This module equips inpatient care managers to understand the etiology of developmental and intellectual disabilities, the mandates that impact service delivery for individuals with intellectual or developmental disabilities, explores the needs typically found in this patient population, and provides tools for communicating and interacting with persons with intellectual or developmental disabilities in the healthcare setting.

Clear and meaningful communication is essential to improving quality of service, interpersonal and professional understanding, and client-professional interaction. This course will show care managers how to apply techniques for clarifying messaging; describe communication challenges and solutions for verbal and non-verbal communication; consider how cultural insensitivity can create communication challenges; and help learners apply techniques for managing emotions during communication.

Arranging and delivering quality care to special populations requires a clear understanding of the challenges and barriers patients within these populations may experience. In this module, participants will learn how to define diverse populations; explain the significance of diverse populations within the healthcare system; describe barriers to care for diverse populations; and identify resources/programs available for various diverse populations.

Domestic violence is present across all populations regardless of income, education, or sexual orientation. This module describes different types of domestic violence; provides examples of the characteristics of victims and perpetrators; explores available resources for those affected by domestic violence; and will support inpatient care managers in helping to reduce the stigma and make a difference to victims of domestic violence.

This course explores the needs and challenges typically present in eight complex-care populations and provides tools and strategies that hospital care managers can use to understand and address them. Course modules examine historical and societal contexts for each population; potential biases and healthcare barriers affecting patients within each special population; communication strategies and other tools inpatient care managers can utilize to ensure effective care; and available resources to support patients and their families across the continuum of care

This in-depth course equips hospital care managers to better coordinate care for patients and families with chronic illness and complex care needs. The curriculum includes in-depth education that helps care managers more effectively engage and educate patients and families, improving informed decision-making and patient satisfaction.Through this training, your care management team will also develop a deeper grasp of palliative care and hospice, including how they differ; how to assess physical, spiritual and psychosocial suffering; how to determine eligibility and work with payers; and how to have difficult conversations with patients and families.

The Healthcare Management and Delivery module provides an overview of the key factors that created today’s care management models: healthcare delivery systems, professional educational requirements, healthcare innovations, advocacy groups, governmental engagement, and payment models.

This module provides an in-depth look at the practice of self-disciplined reasoning including emotional reasoning, pragmatic reasoning and epistemic reasoning. Care managers will learn strategies to improve critical thinking skills and apply the concepts of critical thinking, reasoning, and reflective thought in their work with patients and providers.

Care managers need effective strategies to cope with the stress and challenges that often accompany their work. This course will describe why peer support is important and where to find it; examine the differences between stress and burnout; identify signs and symptoms of burnout and how to prevent it, neutralize it, or recover from it; define civility; and apply strategies for mitigating incivility and championing civility in the workplace

This interactive, self-paced online course is designed specifically for utilization review professionals in acute-care settings who need expert skills and strategies focused on examining costs, improving efficiencies, and ensuring patients receive the highest quality care.

As the American population ages, healthcare systems and workers must rise to meet the challenges necessary to care for older individuals. This module examines care options for older patients who cannot live at home; chronic medical conditions affecting older Americans and the impact they have on patients, families, and healthcare systems; and strategies for managing transitions of care for older patients.

Holistic healthcare is the expansion of medical care beyond the management of physical disease to an approach that encompasses “the whole person.” Quality of life is an important aspect of holistic healthcare as it reflects the patient’s perceptions of their overall health and general well-being. In this course, you will explore how the quality of life impacts medical outcomes and learn specific interventions in holistic healthcare that can be applied in an inpatient setting and across the continuum of care.

This module explores the challenges and barriers immigrants face when seeking healthcare, and provides strategies and resources that care managers can utilize to better serve this population including practicing cultural competency, listening to fears and concerns, explaining Medi-Cal’s Permanently Residing Under Color of Law (PRUCOL) category and how to assist with program enrollment, and more.

This module will provide inpatient care managers with a basic understanding of the effects of incarceration on individuals, as well as essential skills for providing appropriate care to inmate populations. Learners will explore the prevalent health needs of incarcerated individuals, including chronic diseases, mental and behavioral health conditions, and substance abuse disorders; communication skills and other strategies for effectively treating these patients; and social challenges facing this population including risks and obstacles common after release.

This module provides an in-depth examination of the tools, resources, and frameworks used to optimize healthcare quality. Specific topics include the role of metrics, prioritizing and planning quality improvement initiatives, and the importance of integrating an interdisciplinary approach.

This module examines the laws, regulations, and accreditations that most commonly impact case management in a hospital setting including the Emergency Medical Treatment and Active Labor Act (EMTALA), the Caregiver Advise, Record, Enable (CARE) Act, and the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act, and several others.

This module delivers an overview of LGBTQ+ healthcare incongruities and provides care managers with an LGBTQ+ affirmative approach for working with patients. You will explore the unique healthcare needs of the LGBTQ+ population, strategies for communicating and addressing those needs, and resources to incorporate into discharge planning following an inpatient hospital admission.

Understanding how pain affects the whole person provides the foundation for developing a comprehensive pain management program. This module equips inpatient care managers to identify and address co-occurring psychosocial or behavior concerns associated with pain, develop effective strategies for managing pain, and apply collaborative treatment plans that can powerfully manage pain without opioid use.

This module will deliver skills and strategies that equip inpatient care managers to best support patients with mental illness. You will learn common myths and misconceptions about mental illness, develop a deeper understanding of commonly presenting mental disorders, identify typical needs and barriers to care, best practices for working with people with mental disorders; and more.

This module reviews the basic tenets of quality in healthcare. It defines the concept of healthcare quality and explores how to identify areas of improvement, how to articulate key performance indicators and quality metrics, how to discuss quality management tools and apply them in different circumstances, and more.

Culture influences how people perceive illness and death, how they experience healthcare, and how they make healthcare decisions. In this course, you will examine the five major world cultures, learn best practices for avoiding stereotypes and practicing cultural competence, and apply strategies for collaborating and communicating for patients and their families and promoting an environment that champions inclusion and diversity.

Person-centered care hinges on a multidisciplinary approach that recognizes the value of each member of the team. This course will define the purpose of multidisciplinary teams, and the potential challenges and solutions to developing them; the role of various professionals within the team; the differences between communication and collaboration; and best practices for effective communication and collaboration within the team.

Palliative care offers life-changing benefits to patients and families experiencing serious illness. This module equips participants with the comprehensive tools to educate patients, families and colleagues about palliative care; understand the concepts of beneficence and autonomy; communicate clearly and compassionately when sharing difficult news; and assess physical, psychological and spiritual suffering that could be addressed with a palliative care referral.

This course helps care managers elevate their practice by delivering tools that enhance the way they work with patients, families, and other members of the care team. You will examine quality of life and holistic health as it relates to care management; how a patient’s culture and socioeconomic circumstances affect their health; and how to apply best practices for understanding, communicating, and coordinating care for patients within the context of their culture and circumstances. You will also discover how to balance patient and provider demands for tests, procedures, and medications, and learn proven methods for solving problems among teams.

By the end of this module, participants will be able to define patient engagement and supporting concepts; explain how patient engagement impacts health outcomes, patient and family experiences, and healthcare costs; administer patient engagement measurement tools; apply strategies for improving engagement and sustaining patient and engagement; and more.

This module explores the complex relationship between insurers, payment models, clinical documentation, coding, and diagnostic-related groupings, and how they impact patient care and organizational reimbursement.

This module provides an overview of unique issues related to the care of children with complex care needs and their families; common conditions the care manager may encounter within the pediatric population; insurance and coverage issues for children; and important issues to consider related to discharge planning to optimize transitions across the care continuum.

This module provides an overview of unique issues related to the care of children and their families; common conditions, symptoms, and care management considerations in pediatric populations that the utilization review professional may encounter; insurance and coverage issues for children; and important issues to consider related to discharge planning to optimize transitions in care across the care continuum.

This module explores the various types, causes, and characteristics of physical disabilities, as well the disparities that exist due to physical disabilities. Topics include health promotion and disease prevention opportunities, disability etiquette, family and caregiver support, payment systems, community support systems, and best practices.

Homelessness is a problem affecting many areas of society. This module will assist care managers in understanding the causes of homeless, working with people who experience homelessness, as well as people who are at risk of homelessness. You will learn to recognize specialized health needs, risks, and concerns among those experiencing homelessness; how to apply best practices for people who are homeless; common resources and requirements for discharge of people experiencing homelessness; and more.

Pregnant women are high-need patients who commonly require specialized interventions. This module covers all phases of pregnancy from preconception to postpartum care. It describes common causes of morbidity in the normal childbearing population, prevention measures, resources to support patients on specific issues related to pregnancy, and cultural and social barriers that can pose challenges to accessing care.

This online course focuses on the fundamental skills and knowledge that inpatient case managers must master to maximize their effectiveness and achieve optimal patient outcomes. Presented in six engaging modules that can be taken together or separately, the content ranges from key case management concepts and principles of practice, to healthcare management and delivery, legal issues for hospitals, peer support and burnout prevention, and critical thinking that leads to efficient problem-solving.

Collaborative and respectful working relationships optimize teamwork, improve healthcare delivery, and enhance patient outcomes and satisfaction. This course examines the importance of collaboration and effective communication within multidisciplinary teams, and delivers strategies for assessing, improving, measuring and sustaining patient engagement. It also explores how care managers can use active listening, clarifying messaging and other effective communication techniques to engage patients and other providers.

This module will review the essential tenets of risk management in healthcare, and the important role that care management leaders and front-line staff have in preventing, mitigating, and addressing potential health, financial, and organizational risk.

This module prepares inpatient care managers to identify a person with risky substance use behavior, Substance Use Disorder (SUD), or addiction. Topics include strategies for arranging and providing appropriate care, engaging with patients and their families, and coordinating effective interventions and supportive resources to assist in reducing substance use or aid in beginning recovery.

Team problem solving is effective in promoting care management skills, improving quality of service, building critical thinking skills, enhancing wellness and coping skills, and promoting best practices for improved patient outcomes. In this course, you will learn strategies for team problem solving, tools for maximizing innovative collaboration, and best practices for motivating team problem solving.

For a patient in need of an organ transplant, waiting for a donor organ is often the most difficult part of the process. Success in receiving a transplant often depends on the patient’s ability to manage their care, problem solve, and navigate the insurance system. This module explores the societal, situational, and personal barriers to receiving a transplant, and gives care managers tools and resources to assist patients in this journey.

Brain injuries are sudden catastrophic life events that significantly affect the injured person and those closest to them. This module examines types of brain injury and their symptoms, the special needs of brain injury survivors and the special skills and available resources that are effective in supporting and communicating with brain injury survivors and their support networks.

This module provides a historical evolution of utilization management, an overview of the roles and responsibilities of a utilization review specialist, credentials required, the types of reviews they perform, information on the type of health insurance plans with which they interact, and the value they bring to the hospital team related to optimizing appropriate use of hospital resources.

This course provides an overview of the key factors that created today’s care management models: healthcare delivery systems, professional educational requirements, healthcare innovations, advocacy groups, governmental engagement, and payment models.

This module delivers an overview of common legal issues encountered in hospital utilization management. It explores the key elements of EMTALA, requirements of the CARE Act, the utilization review manager’s responsibility as a mandated reporter, CMS utilization review, the Anti-Kickback Statue, various compliance requirements, and a healthcare provider’s responsibility under the exclusion act.

As part of the team that guides patients through their hospitalization and payment systems, care managers and utilization review managers share several responsibilities informed by a clear understanding of issues such as confidentiality, informed consent, patient rights, and other factors. This module explores the fundamentals of utilization review case management, from ethics to counseling considerations to reimbursement for inpatient hospital care.

This module examines key components of managing healthcare value and resources, including understanding the Triple and Quadruple Aim; identifying under- and overutilization of care and how to manage them; defining service recovery and how to engage in it for better outcomes; and exploring how prescribed medications (formulary and non-formulary) affect value, resources, and optimal levels of patient care.