About this Self-paced Training

Explaining Utilization Management (UM) for HPA

This course leads learners through an end-to-end deep dive into the HPA standards for Utilization Management (UM). Through this course, presenters will provide you with insight to interpret the requirements, navigate the standards, and avoid misconceptions. In addition to answering live questions, the presenters address scenarios and examples based on performance improvement opportunities from prior NCQA surveys.

Please note, this course includes standard updates for HPA surveys conducted between July 2025 and July 2027."

What You Will Learn

At the conclusion of this course, learners will be able to:

• Understand the 2024-2025 updates and changes to the standards and requirements.
• Interpret the intent of HPA requirements.
• Describe relationships and themes across the standards.
• Recognize requirement implications and considerations for stakeholders.
• Define performance improvement opportunities.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Who Should Attend

Clinicians, executives, managers, specialists, consultants, delegates, and vendors who are employed or contracted by health plans with responsibilities pertaining to the scope of work listed below:

• Health care professional.
• Health decision makers
• Consultant.
• Health plan.
• Health Systems
• Population health organizations

Faculty

Irv Koehler, RN, MBA, CPHQ, CPC

Irv Koehler is a health care quality consultant for the Koehler Quality Group, LLC. In this position, he is an NCQA administrative surveyor and provides consulting services to organizations evaluating and preparing for NCQA Accreditation/ Certification projects, risk adjustment validation for managed care organizations, education on quality improvement practices and outcome measure development and tracking.  

Mr. Koehler is also a registered nurse with active licensure in Florida and Tennessee, and certification in quality and medical coding. Previously, he was a quality improvement professional at AmeriHealth Caritas and BlueCross BlueShield of Tennessee.

Mr. Koehler has an MBA from the Florida Institute of Technology, a BS in Nursing from Florida Southern College, a BA in Psychology and an ADN from Purdue University.

Clint Koenig, MD, MSPH, MA

Clint Koenig, MD, MA, MSPH is the Senior Medical Director at OhioHealthy, a new system-based health plan in Columbus, Ohio. He has served as State Medical Director in New Hampshire and Ohio. Other leadership roles include the Health Plan Regional Chief Medical Officer at Universal American, a government programs health management organization in Syracuse, New York, as well as, the Director for Utilization Management at Monroe Plan for Medical Care, a healthcare management organization in Rochester, New York. In addition, Clint held Chief Medical Officer roles in Federally Qualified Health Centers and integrated delivery systems.

He has been an NCQA surveyor for 10 years and surveys health plans, Patient Centered Medical Home, Special Needs Plans and Long Term Services and Supports organizations.

Dr. Koenig received his MD from Albany Medical College in Albany, New York. He completed his residency in Family Medicine, from the University of Missouri. He also completed a fellowship at the University of Missouri, where he received a master’s degree in Public Health and Journalism.

Continuing Education

This self-paced course grants 4.0 Continuing Education Unit (CEU) points for PCMH Certified Content Experts.
This is a non AMA PRA Category 1 CreditTM, ANA CNE, ACPE activity.
* Please note – You must attend the entire program to be eligible for total number of contact hours. 

Disclosure of Relevant Financial Relationships 

The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.

For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution.  For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.

Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Relevant financial relationships exist with the following companies/organizations:

Faculty:
Irv Koehler: None
Clint Koenig: None

Additional Planning Committee Member:
Felicia Khaalid: None
Vincent Pereira: None

This program was developed in part by NCQA staff.

This program received no commercial support.