About this Learning Activity

Delegation 301: Advanced - Oversight for Utilization Management

Throughout the course, learners engage with realistic case studies, examine sample files, and apply oversight techniques while receiving practical guidance from seasoned subject‑matter experts. The experience focuses on building a strong oversight structure that supports audit readiness and aligns with regulatory and accreditation expectations. Participants walk away with actionable tools and insights they can immediately put to work within their organizations. Moreover, this session complements the NCQA toolkit for NCQA Delegation: https://www.ncqa.org/making-the-most-of-your-delegation-practical-guidance-for-health-plans/

Learning Materials

• Recording of live sessions
• Presentation slides
• Applied scenarios
• Live Q&A (during live session only)

Benefits

• Perspectives of an NCQA Surveyor
• Practical applications                                    

What You Will Learn

Topics

• Use cases in Utilization Management
• Effective Collaboration
• Recurring Audits
• Delegated Functions
• Performing Monitoring and Reporting

Learning Objectives

By participating within this learning activity, learners will:

• Analyze the organization’s retained accountability for utilization management within delegated arrangements.
• Evaluate the effectiveness of delegation oversight structures—such as monitoring, reporting, audits, and corrective action.
• Refine delegation oversight procedures that strengthen organizational accountability, mitigate risk, and ensure consistent utilization management outcomes.

Learning Outcomes

By completing this learning, learners will be equipped to:

• Align reciprocal expectations to achieve target outcomes.
• Validate the effectiveness of oversight practices for delegated functions.
• Optimize oversight communications effectively to internal leadership and delegated partners

Who Should Attend

• Utilization Management leaders, clinicians, directors, managers, specialists, and coordinators.
• Partners, consultants, contractors, delegates, and vendors who support utilization management teams.
• Professionals in quality assurance/improvement or performance measurement.

Faculty

Kimberly Petit, MBA  

Kim began consulting in 2017, drawing from her numerous and varied accreditation experiences, she has successfully guided many organizations through the preparation and achievement of NCQA-Accreditation and Certification. Prior to consulting, Kim was the Sr. Director, Head of QM Program, Accreditation, Credentialing and Delegated Credentialing for all Commercial, Medicare and Exchange product lines across Aetna, Coventry and Joint Ventures. In this role, Kim had accountability for setting strategy and overall execution of the National Quality Program to meet regulatory requirements and maintain NCQA accreditation.

Kim has her MBA from the Kellstadt Graduate School of Business at DePaul University and her BS from the University of Illinois, Champaign-Urbana. Kim serves as a surveyor for the National Committee for Quality Assurance since 2009. She also served an adjunct professor at the Kellstadt Graduate School of Business, teaching MGT 510: Health Technology, Informatics & Quality, a Health Insurance Industry Perspective. Kim lives west of Chicago on an organic farm with her husband and son.

In her spare time Kim is an avid tennis player.

Continuing Education

This course grants 1 Other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.

This is a non AMA PRA Category 1 Credit™, 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:
Kimberly Petit: None

Additional Planning Committee Members:

Julie Pung: None

Vince Pereira: None

This program was developed in part by NCQA staff.

This program received no commercial support.