APFM Section 3 Module 3: Utilization Management Administration

Module Description

Utilization management can be resource-intensive and require significant administrative operations. This module will explore electronic prior authorization and gold carding and their significance in utilization management operations. Learners will be able to identify sources of administration burden and strategies to address them. Lastly, this module will identify the different types of smart logic systems along with their benefits and challenges in utilization management operations.

 

Target Audience

This program is designed for mid-level managed care pharmacists and managed care professionals working in formulary management or considering a transition to formulary management. 

Learning Objectives

At the completion of this activity, participants should be able to:

  • Define electronic prior authorization and its significance in utilization management operations.
  • Describe gold carding and its role within utilization management.
  • Identify sources of administration burden and strategies to address them.
  • Recognize the different types of smart logic systems and their benefits and challenges in utilization management.

 

Course summary
Available credit: 
  • 0.75 ACPE
    ACPE The Academy of Managed Care Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
  • 0.75 Certificate of Completion
Course opens: 
12/13/2024
Course expires: 
12/13/2027
Cost:
$0.00
Part of: 
Advanced Principles of Formulary Management

Faculty/Author:

Goldina Erowele, PharmD, MBA
Pharmacy Advisor/Consultant
KJC Media Health 

Advisory Board

Shawn Barger, PharmD
Lead Director, Medicare Formulary Development and Management
Password

Aimee Loucks, PharmD, BCPS
Director Clinical Pharmacy Services
Kaiser Permanente Washington

Lisa Mahan, PharmD, MS, MTM
Clinical Program Senior Manager
Cigna Healthcare

Kristen Patti, PharmD
Manager, Clinical Drug Evaluation & Policy
Blue Cross Blue Shield of Michigan

Reviewers

Steve Kheloussi, PharmD, MBA, FAMCP
Director, Professional Affairs
AMCP

Katherine Tieu, PharmD
Clinical Account Manager
Capital Rx

Drake Reiter, PharmD
Director, Pharmacy Operations
Priority Health

Financial Relationship Disclosures:

Faculty/Reviewer/PlannerReported Relevant Financial Relationships
Goldina Erowele, PharmD, MBA
Faculty		Cigna Healthcare, Employer
Shawn Barger, PharmD
Planner		None
Aimee Louckes, PharmD, BCPS
Planner

None

Lisa Mahan, PharmD, MS, MTM
Planner		None
Kristen Patti, PharmD
Planner		IngenioRx
Steve Kheloussi, PharmD, MBA
Reviewer		None
Drake Reiter, PharmD
Reviewer		None
Katherine Tieu, PharmD
Reviewer		None
  • AMCP Staff have disclosed no relevant financial relationships.
  • If applicable, relevant financial relationships have been mitigated and documented.
  • Content has undergone a peer review to ensure content validity.

Accreditation:

ACPE UAN:0233-0000-24-077-H04-P • Activity Type: Knowledge-Based
Contact Hours: 0.75
Release Date: December 13, 2024 •  Expiration Date: December 13, 2027

CPE credit will be processed through the AMCP Learn portal and reported directly to CPE Monitor. Please allow 72 hours for processing and posting in your NABP account.

To receive credit for an online activity you must:

  • Review the full content of the activity.
  • Successfully complete the post-test (required to pass with a score of 70% or higher, it may be taken a maximum of three times).
  • Complete a specific activity evaluation.

Available Credit

  • 0.75 ACPE
    ACPE The Academy of Managed Care Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
  • 0.75 Certificate of Completion

Price

Cost:
$0.00
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