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Who should take the AHM-540 exam
- Agents and brokers who expert in life and health insurance
- Financial executives working with clients looking to maximize their health dollars
- Case administrators and medical directors who inquire a broader administrative background
- Employees who work for health care providers or health insurance plans and want to get the educational background to proceed with a management position in the industry
- Teachers at the school level who teach health care administration
- Medical management employees working in hospitals, health systems, and, health insurance plans
Reference: https://www.ahip.org/courses/medical-management-ahm540
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AHIP AHM-540 Exam Syllabus Topics:
| Section | Objectives |
|---|---|
| Utilization Management | - Concurrent and retrospective review - Preauthorization and precertification processes - Medical necessity review |
| Quality Management and Improvement | - Performance improvement strategies - Quality measurement and reporting |
| Care Management and Coordination | - Transitions of care - Disease management programs - Case management principles |
| Introduction to Medical Management | - Concepts and objectives of medical management - Role of medical management in health plans |
| Regulatory and Ethical Considerations | - Member rights and confidentiality - Compliance in medical management |

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