AHIP AHM-540 - Medical Management

AHIP AHM-540 Actual PDF
  • Exam Code: AHM-540
  • Exam Name: Medical Management
  • Updated: Jul 28, 2026
  • Q & A: 163 Questions and Answers
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About AHIP AHM-540 Exam

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How much AHM-540 Exam Cost

The price of the AHM-540 exam is 220 USD for AHIP members and 280 USD for non-members.

Reference: https://www.ahip.org/courses/medical-management-ahm540

How to book the AHM-540 Exam

These are following steps for registering the AHM-540 exam. Step 1: Visit to AHIP Exam Registration Step 2: Signup/Login to AHIP INSURANCE EDUCATION account Step 3: Search for AHM-540 Exam Certifications Exam Step 4: Select Date, time and confirm with payment method

AHIP AHM-540 Exam Syllabus Topics:

SectionObjectives
Preventive and Care Management Programs- Case management
  • 1. Management of complex cases
    • 2. Care coordination
      - Utilization management
      • 1. Authorization and utilization review processes
        • 2. Medical necessity review
          - Preventive care and self-care programs
          • 1. Member education and wellness
            • 2. Health promotion initiatives
              - Disease management
              • 1. Population health management
                • 2. Chronic disease programs
                  Clinical Practice and Quality Management- Clinical practice management
                  • 1. Evidence-based clinical guidelines
                    • 2. Medical policies and practice parameters
                      - Quality management
                      • 1. Quality assessment
                        • 2. Quality improvement methodologies
                          • 3. Performance measurement
                            Medical Management Across Care Settings- Medical management for government-sponsored programs
                            • 1. Medicaid
                              • 2. Other government-sponsored programs
                                • 3. Medicare
                                  - Medical management for acute care
                                  • 1. Acute care strategies
                                    • 2. Post-acute care management
                                      - Medical management for pharmacy services
                                      • 1. Pharmacy benefit management
                                        • 2. Specialty services management
                                          The Medical Management Function- Role of medical management
                                          • 1. Delegation and subdelegation of medical management functions
                                            • 2. Medical management committees
                                              • 3. Goals and components of medical management programs
                                                • 4. Responsibilities of the medical director
                                                  - Environmental influences on medical management
                                                  • 1. Federal and state regulatory requirements
                                                    • 2. Purchaser, provider, and member expectations
                                                      • 3. Accreditation organizations and standards
                                                        • 4. Impact of environmental factors on delegation
                                                          - Relationship of medical management to other health plan functions
                                                          • 1. Legal affairs
                                                            • 2. Risk management
                                                              • 3. Finance
                                                                • 4. Claims administration
                                                                  • 5. Sales and marketing
                                                                    • 6. Information management and technology
                                                                      • 7. Network management

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