For Nurses

Utilization Management Nurse Master Class

Looking to enhance your career and improve our health system at scale? Joining a managed care organization as a Nurse reviewer is a meaningful opportunity to apply your clinical expertise to improve the quality and cost of care.

Join our Nurse Reviewer Class with experienced instructors. This course is ideal for clinical nurses looking to expand their careers in the Managed Care environment.

Learn the skills to determine medical necessity, to save patients’ time and money, as well as. the knowledge and mindset to succeed in health plan roles.

This course will be launching later in 2024! Sign up for updates.

Learning structured to fit into clinicians' lives

Format

  • 4 live sessions

  • 4-6 hours total learning time

  • Written examination

Pre-requisites

  • Unrestricted nurse license in state of practice

  • 5 year clinical experience in a hospital setting

  • Not excluded by OIG or SAM

You will learn

  • Key concepts of Utilization Management and the role it plays in determining medical necessity

  • The roles that nurses and physicians play in UM

  • Medical Management processes to assure quality and cost effectiveness in clinical care delivery

  • The different aspects of Medical Management

  • Discussions on Line of Business variations

  • The components of the Federal Medicare program

  • Various clinical criteria that are used and their differences

  • The different levels of appeals

Nancy Eberhard

BSN, RN, CMCN, CHC

Nancy Eberhard is a Senior Clinical Consultant at Toney Healthcare, with a career spanning roles as Corporate Compliance Officer, Corporate Director of Quality and Health Services Compliance and Senior Manager of Medical Management. Nancy brings a wealth of knowledge in healthcare management, clinical operations, data analysis, healthcare compliance, utilization review, managed care nursing, and quality program development. Her track record includes national and regional leadership in Utilization Management and Quality Operations, with a focus on ensuring compliance and driving clinical performance improvement.

Nancy earned a BSN from DePauw University and holds RN licenses in multiple states and CHC/CMCN certifications.