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AHM Medical Management AHM-540 Exam is designed by the Academy of Health Care Administration (AHM) and sponsored by the US Health Insurance Plans and the Blue Cross Blue Shield Association. AHM is a self-study examination based program. AHM-540 Exam validates candidate has knowledge about the medical policy and technology evaluation, appropriateness of care issues, authorization systems, and clinical practice guidelines. This exam also verifies the candidate has the ability to discover focused strategies for utilization management, such as clinical paths and disease management. This exam also evaluates the candidate proficiency in accreditation, quality improvement, benchmarking, performance measurement, and legal aspects of QM, as well as QM strategies for different clinical settings.
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The AHM Medical Management AHM-540 Exam certification path includes only one AHM-540 certification exam.
Reference: https://www.ahip.org/courses/medical-management-ahm540
| Section | Weight | Objectives |
|---|---|---|
| Specialized Services | 15% | - Telemedicine and virtual care - Pharmacy benefit management - Behavioral health integration |
| Utilization & Quality Management | 25% | - Quality measurement and improvement - Accreditation standards (NCQA, CMS) - Utilization review processes |
| Role of Medical Management | 20% | - Delegation and accountability - Overview in health insurance organizations - Regulatory and legal framework |
| Care Management Programs | 25% | - Disease management principles - Preventive and self-care programs - Case management for complex patients |
| Government Programs | 15% | - Compliance with federal regulations - Medical management for Medicaid - Medical management for Medicare |
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