The Role of Artificial Intelligence in Utilization Management – Enhancing Healthcare Decision-Making

Current Status

Not Enrolled

Price

$69.00

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📢 Earn 3 CE Contact Hours! – BRN Approved

 Course Overview

Artificial Intelligence (AI) is transforming Utilization Management (UM), medical necessity reviews, and workflow automation. This self-paced, online course provides practical knowledge for nurses, case managers, and healthcare administrators on how AI enhances decision-making while addressing ethical and regulatory considerations.

  • Explore AI-driven UM innovations
  • Analyze real-world case studies on AI in healthcare
  • Understand compliance with CMS, NCQA, and URAC guidelines

Upon completion, participants earn 3 CE contact hours, approved by the California Board of Registered Nursing (BRN).

Course Objectives

By the end of this course, you will be able to:

  •  Define AI and its applications in healthcare utilization management.
  • Describe how AI enhances decision-making in medical necessity reviews.
  • Evaluate AI-driven predictive analytics, automation, and cost efficiency.
  • Analyze ethical concerns, regulatory requirements, and compliance risks.
  • Apply best practices for integrating AI in UM workflows.

Course Format & Learning Experience

  • 💻 100% Online & Self-Paced – Learn at your convenience!
  • 📚 Engaging Content – Case studies, interactive quizzes, and downloadable resources.
  • 📜 Earn Your CE Certificate – 3 BRN-approved contact hours upon completion.

Who Should Take This Course?

  • Utilization Management Nurses
  • Case Managers & Healthcare Administrators
  • Compliance & Quality Improvement Professionals
  • Anyone interested in AI-driven healthcare solutions

Course Pricing & Enrollment

  • Standard Price: $69
  • 📧 Questions? Contact Us: polina@medscholaria.com

Instructor Bio

Polina Obshchanska, BSN, RN – Lead Utilization Management Nurse, Continuing Education Provider, and MSN student in Nurse Administration. Polina has almost 10 years of experience in healthcare, including hospice, case management, utilization management and healthcare quality, and is the founder of Medscholaria Consulting, Inc., a BRN-approved CE provider focused on empowering nurses through relevant, timely, and nationally impactful education.

Refund & Cancellation Policy

If a participant cancels their enrollment within 48 hours of purchase, they are eligible for a full refund. No refunds will be issued for incomplete or partially completed courses. If MedScholaria Consulting INC cancels the course, a full refund will be processed within 10 business days.

📜 BRN Provider Statement

“Provider approved by the California Board of Registered Nursing, Provider Number CEP18046, for 3 contact hours.”

Course Content

Module 1: Introduction to Artificial Intelligence in Utilization Management (30 min)
Lesson 1: AI in Healthcare & Utilization Management (UM) 2 Topics
Module 2: AI-Driven Decision Support in Utilization Management (45 min)
Lesson 3: AI in Medical Necessity Reviews & Pre-Authorization 1 Quiz
Lesson 4: Predictive Analytics & Risk Stratification 1 Quiz
Module 3: Ethical and Regulatory Considerations (45 min)
Lesson 7: Addressing AI Bias & Ethical Challenges 1 Topic | 1 Quiz
Module 4: AI Implementation in Utilization Management – Case Studies & Best Practices (60 min)
Course evaluation
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