Microcredential Program

Turn UM Experience into Verified Expertise

Validate your skills, strengthen performance, and advance your role with a focused, CMSA-issues microcredential—without the time commitment of full certification.

Download Handbook Apply Now

Why UM Matters Now?



Quality

Right care. Right time. Evidence-based UM decisions that support better outcomes.



Cost

Smarter utilization. Reduce waste while protecting organizational performance.



Compliance

Confident decisions. Consistent, defensible UM practice aligned with standards.

Utilization management directly impacts patient outcomes, organizational performance, and regulatory standing.

What This Microcredential Does

As UM grows more complex, case managers must balance clinical judgment, compliance, and communication in real time. The CMSA Utilization Management Microcredential validates these skills through a focused, competency-based program—without the time commitment of full certification.

Validates real‑world UM decision‑making
Builds confidence and consistency in practice
Aligns with CMSA Standards of Practice
Designed for immediate workplace relevance

Why Earn the UM Microcredential?

This microcredential recognizes what you can do—not just what you know.

Prove your UM expertise to employers and stakeholders
Strengthen foundational skills before pursuing certification
Expand your role within care management, quality, or revenue teams
Support organizational goals for compliance and utilization accuracy
Earn a verified digital badge you can share anywhere

Who Is This For?

Utilization Management Professionals

Case Managers (Acute, Post Acute, Managed Care)

Nurses & Social Workers in UM roles

Professionals transitioning into UM

Organizations seeking standardized UM validation

Microcredential vs Certification

UM Microcredential	Certification
Targeted focus	Broad, multi-domain
Faster to complete	Longer preparation
Competency-based	Comprehensive mastery
Lower cost	Higher cost

What You’ll Be Tested On

Scenario‑based questions in the following topics evaluate applied knowledge—not memorization.

Foundations of Utilization Management

Definition, purpose, and evolution of UM
Case manager's role in cost control, advocacy, and utilization oversight
Key UM concepts: medical necessity, appropriateness, efficiency
Managed care origins and influence on UM practices

Tools, Guidelines & Regulatory Frameworks

Clinical decision support tools: InterQual, MCG
Application of CMS Conditions of Participation (CoPs)
Understanding MOON, HINN, ABN notifications
Determining level of care: inpatient, observation, SNF, home health
Payer policies, prior authorizations, and regulatory compliance

Documentation & Communication

Essential components of accurate UM documentation
Types of reviews: admission, concurrent, retrospective
Scripting techniques for provider interaction
Clear documentation to support medical necessit

Denials, Appeals & Revenue Integrity

Types and causes of denials (technical, clinical, administrative)
Strategies to prevent denials and reduce financial risk
Writing and supporting successful appeal letters
Role and value of the Physician Advisor in UM processes

Data‑Driven UM

Key performance indicators (KPIs): LOS, avoidable days, readmission
Using analytics to identify trends and gaps
Reporting metrics and performance outcomes
Applying LEAN, Six Sigma, and PDSA in UM practice

Collaboration & Interdisciplinary Practice

Interdisciplinary collaboration for effective UM
Case manager's interface with payers, providers, and ancillary teams
Communicating denials, delays, and needs across disciplines
Building a culture of shared accountability in UM efforts

Exam “At a Glance”

100 multiple choice, scenario-based questions

}

120 minutes

Secure proctoring

80% passing standard