Exam Code: AHM-540
Exam Name: Medical Management
Certification Provider: AHIP
Corresponding Certification: AHIP Certification
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AHM Medical Management AHM-540 Exam

AHM Medical Management AHM-540 Exam is designed by the Academy of Health Care Administration (AHM) and sponsored by the US Health Insurance Plans and the Blue Cross Blue Shield Association. AHM is a self-study examination based program. AHM-540 Exam validates candidate has knowledge about the medical policy and technology evaluation, appropriateness of care issues, authorization systems, and clinical practice guidelines. This exam also verifies the candidate has the ability to discover focused strategies for utilization management, such as clinical paths and disease management. This exam also evaluates the candidate proficiency in accreditation, quality improvement, benchmarking, performance measurement, and legal aspects of QM, as well as QM strategies for different clinical settings.

Reference: https://www.ahip.org/courses/medical-management-ahm540

How to book the AHM-540 Exam

These are following steps for registering the AHM-540 exam. Step 1: Visit to AHIP Exam Registration Step 2: Signup/Login to AHIP INSURANCE EDUCATION account Step 3: Search for AHM-540 Exam Certifications Exam Step 4: Select Date, time and confirm with payment method

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How much AHM-540 Exam Cost

The price of the AHM-540 exam is 220 USD for AHIP members and 280 USD for non-members.

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AHIP AHM-540 Exam Syllabus Topics:

SectionObjectives
The Medical Management Function- Role of medical management
  • 1. Delegation and subdelegation of medical management functions
    • 2. Responsibilities of the medical director
      • 3. Medical management committees
        • 4. Goals and components of medical management programs
          - Relationship of medical management to other health plan functions
          • 1. Information management and technology
            • 2. Risk management
              • 3. Sales and marketing
                • 4. Legal affairs
                  • 5. Network management
                    • 6. Claims administration
                      • 7. Finance
                        - Environmental influences on medical management
                        • 1. Impact of environmental factors on delegation
                          • 2. Federal and state regulatory requirements
                            • 3. Accreditation organizations and standards
                              • 4. Purchaser, provider, and member expectations
                                Medical Management Across Care Settings- Medical management for government-sponsored programs
                                • 1. Medicaid
                                  • 2. Other government-sponsored programs
                                    • 3. Medicare
                                      - Medical management for pharmacy services
                                      • 1. Pharmacy benefit management
                                        • 2. Specialty services management
                                          - Medical management for acute care
                                          • 1. Acute care strategies
                                            • 2. Post-acute care management
                                              Preventive and Care Management Programs- Preventive care and self-care programs
                                              • 1. Member education and wellness
                                                • 2. Health promotion initiatives
                                                  - Case management
                                                  • 1. Care coordination
                                                    • 2. Management of complex cases
                                                      - Utilization management
                                                      • 1. Medical necessity review
                                                        • 2. Authorization and utilization review processes
                                                          - Disease management
                                                          • 1. Population health management
                                                            • 2. Chronic disease programs
                                                              Clinical Practice and Quality Management- Quality management
                                                              • 1. Performance measurement
                                                                • 2. Quality improvement methodologies
                                                                  • 3. Quality assessment
                                                                    - Clinical practice management
                                                                    • 1. Medical policies and practice parameters
                                                                      • 2. Evidence-based clinical guidelines

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