Monday Memo  

Weekly update from...
Athena Forum logo

Monday, July 9, 2012
  Clinical Accuracy Spoken Here  

Focus of MCO: Access and UM

With the advent of Managed Care Organizations (MCOs), the emphasis changed from policing to coordination, with facilitation and education of members and providers through utilization management (UM).

The role of a UM program is to focus on providing members with access to quality care and monitoring the appropriate utilization of services.

[Reference: MCO, Module A, Prior Authorization]

  Excellence in Case Mgmt  

Benefits of MCO CM
Concurrent Review

MCO case managers perform timely ongoing concurrent review of patients in a variety of care settings.

As the MCO case management focus moves from prior authorization to concurrent review, the MCO CM role mimics that of the HCM in many respects.

When early conversations confirm benefit requirements, medical necessity criteria are met throughout the stay and duplication of service and never events are controlled, denial rates are not an issue and appeals are unnecessary.

[Reference: MCO, Module B, Concurrent Review]

  Improving Patient Care...  

MCO CMs Need Creative Solutions

What If?

As an MCO case manager can you identify, develop and implement a plan? You can! Refer to Athena Forum MCO course for creative solutions to MCO CM dilemmas.

[Reference: MCO, Module A, Prior Authorizations]


Tom RasmussenTom Rasmussen
Athena Forum


NEW courses coming in 2012

» Sepsis & LOS

» High Risk OB

» Social Work Ethics



Cathy WrightCathy Wright, BSN, RN
Clinical Editor
Athena Forum




Online CE for RN, CCM & LSW
4,000 pages of clinical excellence.

Clinical Excellence® Series
» Asthma
» Behavioral Health
» Colorectal Cancer
» CV Risk: Stroke & MI
» Diabetes
» EOL & Palliative Care
» GI Disorders
» Heart Failure
» Multiple Sclerosis
» Obesity Management
» Pain Management
» Rheumatoid Arthritis
» Women's Health
» Wound Care & Payments

CM Excellence® Series

» Principles of Hospital CM
» Patient Advocacy
» Utilization Management
» Discharge Planning
» Hospital Revenue Cycle
» The MCO Continuum Series®



Athena Forum Help Desk
Mon-Fri 9am-5pm ET

Recommend to a friend
Tom Rasmussen, Publisher

Enrollment & passwords
Janice Graham, Registrar

  Monday Memo Archives
Did you miss an issue? Need to look up a reference in a past Monday Memo? All past issues are archived for your use. Click here.


Athena Forum is pleased to announce NASW approved CE
is now available for the following courses:

EOL & Palliative Care

MCO Continuum

Once you review the course and complete the posttest you can print your CE Certificate.

Athena Forum is the proud provider of web based continuing education
for nurse and social work case managers across the nation.

Athena Forum, LLC awards CE for ANCC - NASW - CCMC

Athena Forum is a world wide service mark in nursing education
by the U.S. Office of Trademarks and Patents.

Copyright 2012 All rights reserved | Headquarters in Boca Raton, FL | 800-583-2506 | www.athenaforum.com