Quality Oversight & Utilization Alignment Training

Info: Month 3 – Quality Oversight and Utilization Alignment

Focus: Sustaining quality through supervision and utilization management.

Topics

• Service authorization, eligibility, and medical-necessity documentation

• Linking documentation to amount, scope, and duration of services

• Supervisory chart reviews and feedback methods

• Using QA and UM data to guide continuous improvement

Objectives

• Reduce findings related to authorization, eligibility, or supervision

• Embed documentation oversight into everyday supervisory practice

Relevant Review Citations

• iSPA E.2.C: Required elements of evaluation/re-evaluation, eligibility timelines, and compliance documentation.

o Utilization Management Themes: Service authorization (amount, scope, duration), medical necessity, and monitoring authorizations.

o Clinical Supervisor Role in QA: Best practices for supervisory chart reviews and documentation monitoring.

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