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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
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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Role of Medical Management | 20% | - Delegation and accountability - Overview in health insurance organizations - Regulatory and legal framework |
| Topic 2: Specialized Services | 15% | - Telemedicine and virtual care - Pharmacy benefit management - Behavioral health integration |
| Topic 3: Government Programs | 15% | - Medical management for Medicaid - Medical management for Medicare - Compliance with federal regulations |
| Topic 4: Utilization & Quality Management | 25% | - Quality measurement and improvement - Accreditation standards (NCQA, CMS) - Utilization review processes |
| Topic 5: Care Management Programs | 25% | - Disease management principles - Preventive and self-care programs - Case management for complex patients |
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