Today’s utilization management programs often struggle to keep up with shifting payer expectations and regulatory changes. Outdated workflows, siloed communication, and limited visibility across the patient continuum leave many organizations reacting to denials rather than preventing them. As payer scrutiny intensifies and traditional processes fail to align with new requirements, especially after the removal of the Inpatient Only List, the operational and financial risks of maintaining the status quo have never been higher.

In this webcast, Tiffany Ferguson introduces an Adaptive Model—a progressive, team-based approach that modernizes utilization review. Attendees will learn how to create specialized roles across the care continuum, integrate non-licensed support and payer-focused functions, and leverage technology-enabled workflows to improve coordination and visibility. Drawing on real-world examples, Tiffany will outline how to build a flexible utilization management infrastructure designed for proactive intervention, stronger clinical collaboration, and measurable financial improvement.

Why This is Relevant:

Acting now is essential. The landscape of utilization management is evolving rapidly, and reactive models are no longer enough to protect margins or compliance. This session equips healthcare leaders with the tools and insight needed to restructure UM operations, align staffing by function, and implement data-driven performance strategies that enhance both efficiency and revenue integrity. Organizations that adapt will lead with clarity and confidence but those that don’t risk being left behind.

Learning Objectives:

• Discover the limitations of traditional utilization review models.
• Understand how the removal of the Inpatient Only List and payer requirements impact pre-surgical, admission, and post-operative workflows.
• Apply strategies for structuring utilization management teams by function.
• Evaluate what is needed to understand staffing models and training requirements for change management.
• Incorporate the role of technology-enabled workflows such as optimized EMR builds.

Who Should Attend:

Physician Advisors, Case Managers and CM Leadership, Utilization Management professionals, and leadership, utilization review, revenue cycle, revenue integrity, compliance management, as well as chief financial officers.