Data-Based and Analytical Decision Making in Case Management
Certificates
Association of Social Work Boards
Relias, LLC, #1273, is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB) www.aswb.org, through the Approved Continuing Education (ACE) program. Relias, LLC maintains responsibility for the program. ASWB Approval Period: 2/10/2018-2/10/2021. Social workers should contact their regulatory board to determine course approval for continuing education credits.
Course Delivery Format: Asynchronous Distance Learning-interaction includes quizzes with questions and answers, posttests. This module is Text-based.
Social workers participating in this course will receive 1.50 Clinical continuing education clock hours.
California Board of Registered Nursing
Provider approved by the California Board of Registered Nursing, CEP# 13791
Nurses will receive 1.50 contact hours for participating in this course.
District of Columbia Board of Nursing
DC-RN -- District of Columbia Board of Nursing Approved Continuing Education program (CE Provider #50-290).
Nurses will receive 1.50 contact hours for participating in this course.
Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling
Provider #50-290 This activity is approved for 1.50 contact hours.
Florida Board of Nursing CE
Florida Board of Nursing CE Provider #: 50-290
Nurses will receive 1.50 contact hours for participating in this course.
American Nurses Credentialing Center
Relias, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Nurses will receive 1.50 contact hours for participating in this course.
New York State Education Department, Office of the Professions, Division of Professional Licensing Services, Social Work Unit
Relias, LLC is recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0009.
Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of licensed master social work and licensed clinical social work in New York. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice for an LMSW and LCSW. A licensee who practices beyond the authorized scope of practice could be charged with unprofessional conduct under the Education Law and Regents Rules.
As a provider of online, asynchronous education, some courses offered by Relias Learning are considered “self-study” under section 74.10(c)(2)(ii)(b)(4) of the Commissioner’s Regulations. The regulations limit self-study activities taken from a provider approved by the Education Department to no more than 12 hours in the 36-month registration period or one-third of the hours in a registration period other than 36 months.
Social workers will receive 1.50 continuing education hours for participating in this course. This activity is approved for 1.50 contact hours.
Georgia Board of Nursing
Georgia Board of Nursing CE Provider #: 50-290
Nurses will receive 1.50 contact hours for participating in this course.
Commission for Case Manager Certification
This activity is approved for 1.50 contact hours.
Course Details
Discuss the background and implications of big data in healthcare.
Describe how data are utilized by case managers within different areas of the payer setting to improve care outcomes.
Summarize how data plays a part in the application of medical necessity criteria and evidence-based guidelines.
Explain how data has the potential to revolutionize healthcare and the challenges associated with bringing this to fruition.
Outline:
Section 1: Introduction
A. About This Course
B. Learning Objectives
Section 2: An Introduction to Healthcare Data
A. Testing Your Existing Knowledge
B. An Introduction to Healthcare Data
C. What is “Big Data” In Healthcare?
D. Where Data Comes From: General Data Realms
E. Four Sources of Healthcare Data
F. Where Data Comes From: Specific Data Sources
G. Four Steps of Healthcare Data Analytics
H. How Providers are Utilizing Data
I. How Payers are Utilizing Data
J. How Patients are Utilizing Data
K. How Pharmaceutical Industries are Utilizing Data
L. Data Challenges and Future Rewards
M. Data Sourcing, Storage, Quality, and Veracity
N. Data Sharing and Transparency
O. Needed Infrastructure
P. The Need for Privacy
Q. Potential Future Benefits
R. Meet Anna
S. Summary
Section 3: Data-Based Decision Making in the Payer Setting
A. Applying and Utilizing Data in the Payer Setting
B. Area 1: Care Quality and Member Outcomes
C. Area 2: Member Engagement and Preventive Programs
D. Area 3: Chronic Conditions and High Utilizers
E. Area 4: Fraud, Waste, and Abuse
F. Area 5: The Provider Network
G. Data-Based Case Management
H. Achieving Case Management Goals
I. Identification for Case Management Services
J. Critical Measurements During the Case Management Process
K. Outcome Measures as a Benchmark
L. Suggested Measures in Case Management/Care Coordination
M. Case Management Performance Measures
N. Utilization Benchmarks and Best Practice Identification
O. Utilization Reviews and Data-Based Guided Care
P. Identifying Fraud, Waste, and Abuse
Q. Data Measurements for Medical Necessity Adherence
R. Medical Necessity Criteria and Scope
S. Review
T. Summary
Section 4: Detailed Application of Data in Decision Making
A. Common Areas of Data within Case Management
B. Outcome and Utilization Measures for Case Management
C. Driving Better Care through Data
D. Exploring Medical Necessity Guidelines
E. Medical Necessity Guidelines are Evidence-Based
F. Clinical Pathways to Guide Decisions with Data
G. The Benefits of Data-Based Decision Making
H. Review
I. Summary
Section 5: Conclusion
A. Summary
B. Congratulations!
C. Course Contributors
D. Resources
E. References
Danyell Jones is a recognized leader in the healthcare industry with more than 10 years of diverse experience at the executive level. Ms. Jones has been published in a number of leading healthcare industry magazines and journals, and has been responsible for the development and execution of training programs for some of the nation’s largest Managed Care, Insurer, Provider, and Health System organizations. Disclosure: Danyell Jones has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
The target audience for this course is: intermediate and advanced level Case Managers; intermediate and advanced level Nurses; intermediate and advanced level Social Workers; in the following settings: All Healthcare Settings.
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form (https://www.relias.com/help) or by using the chat functionality.
All courses offered by Relias, 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.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
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.
If you require special accommodations to complete this module, please contact Relias Customer Support by calling (800) 381-2321 or emailing [email protected]
