AHM-540 study materials - AHIP AHM-540 dumps VCE

AHIP AHM-540 : Medical Management

Exam Code: AHM-540

Exam Name: Medical Management

Updated: Sep 10, 2026

Q & A: 163 Questions and Answers

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AHM Medical Management AHM-540 Exam

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

What is the duration of the AHM-540 Exam

  • Length of Examination: 120 minutes
  • Format: Multiple choices, multiple answers
  • Number of Questions: 163

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Certification Path

The AHM Medical Management AHM-540 Exam certification path includes only one AHM-540 certification exam.

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AHIP AHM-540 Exam Syllabus Topics:

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

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