About this Learning Series

Utilization Management Accreditation 201: Implementation - Surveys through June 2028

This learning series guides professionals through the standards for the NCQA Accreditation in Utilization Management (UMA). Through these learning modules, participants gain clarity on UM requirements, core processes, and expectations for performance. The course provides practical examples to help organizations make fair and timely determinations about the services’ appropriateness. Implementing practices addressed through this course will help organizations Demonstrate quality to employers, regulatory agencies and health plans.

What You Will Learn

• Clinical Criteria for UM Decisions
• UM Program Evaluation
• UM Information Integrity
• Internal QI Process

• Explain the organizational infrastructure required for efficient Utilization Management (UM) operations.
• Describe the roles and responsibilities for enabling consistent, evidence‑based decision‑making.
• Identify key UM processes including intake, clinical review, peer‑to‑peer consultation, notification, and appeals.
• Recognize organizational obligations for transparency, documentation, and communication throughout the UM process.

• Assess organizational readiness for UM operations by evaluating policies, staffing, workflows, and controls that support quality and compliance.
• Evaluate UM decisions for alignment with evidence‑based criteria, regulatory requirements, and member safety.
• Demonstrate effective UM governance by outlining how UM committees review program performance, identify risks, and implement corrective actions.
• Document and communicate UM activities in a manner that supports accountability, auditability, and continuous organizational learning.                                                                                

Who Should Attend

• Clinicians, executives, managers, and specialists working in utilization management or medical management.
• Consultants, delegates, vendors, and partners supporting UM functions.
• Accreditation, compliance, and quality assurance professionals involved in UM oversight.

Continuing Education

This course grants 4 Other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

This is a non AMA PRA Category 1 Credit TM, 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:

This program was developed by NCQA staff.
This program received no commercial support.