Utilization Management is an invaluable resource in handling time and reducing management costs in the healthcare space. When a nurse has proper training in Utilization Management, they are equipped to evaluate the appropriateness of care, and ensure decisions are made properly. Shearwater Health is committed to ensuring our nurses have proper training in Utilization Management through our UM Academy and our recent partnership with MCG Health to scale an organization’s needs.
Knowing the lack of Utilization Management protocols being taught in nursing school, Shearwater saw an opportunity to teach these valuable skills in depth. Utilization Management goes beyond guidelines; there are many regulations, adherences, and legal ramifications that, without proper training, a RN wouldn’t be aware of. UM training provides a nurse with the knowledge of why they are processing the case, what the importance is, how to adhere to turnaround times and documentation guidelines, and ensuring compliance to save time, money, and resources. Through Shearwater’s accredited UM Academy training material, nurses will learn fundamental concepts in a skillset that is in high demand in the healthcare industry. All Shearwater nurses who have completed our UM Academy training and sat for their exam through ABQAURP (American Board of Quality Assurance and Utilization Review) have passed; a statistic that speaks volumes to the credibility of our Academy and our nurses.
In addition to our ABQAURP training material accreditation, we are excited about our recent MCG Health partnership and what this means for our nurses going through the Academy. MCG Health, part of the Health Heart network, is an industry leader in technology-enabled, evidence-based guidance. MCG Health care guidelines are currently licensed by over 2,800 hospitals and most U.S. health plans, making them a trusted clinical language between providers and payers. Multiple case studies have shown that the utilization of MCG Health helps guide care according to best practices while mitigating unnecessary costs and risks to patients. Shearwater Health nurses will be trained to utilize these guidelines to review medical necessity requests and approve cases that meet the appropriate criteria during their time in the UM Academy. Health plans typically sponsor their MCG Health training, but we are excited that we have the chance to train our nurses before they go out into the field.
Lacie Behnke, MSN-Ed, RN, Director of Nursing Education at Shearwater Health stated, “With programs like our UMA, which combines lectures, quizzes, exams, and practice cases in a simulated UM environment, we can create a strong foundational knowledge of UM for our nurses. They can then build upon this foundation for the rest of their careers, and their enhanced knowledge will directly contribute to increased positive healthcare outcomes.” We will continue to work to provide exceptional training and services to our clients and patients both in the Utilization Management space and beyond!
About Shearwater Health
Because of a shortage of clinicians, it’s often difficult to scale healthcare organizations. Shearwater Health provides teams of remote and onsite clinicians that expand the size and impact of clinical teams so that clients can focus on internal teams practicing at the peak of their license. From bedside to back-office, there are over 4,000 Shearwater clinicians solving medical and administrative problems every hour of every day all over the world. Shearwater combines clinical expertise with Six sigma process excellence and RPA technology to improve healthcare outcomes.
