AHIP AHM-540 real exam prep : Medical Management

  • Exam Code: AHM-540
  • Exam Name: Medical Management
  • Updated: Oct 10, 2026
  • Q&As: 163 Questions and Answers

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AHM-540 Exam topics

Candidates must know the exam topics before they start of preparation. Because it will really help them in hitting the core. Our AHM-540 exam dumps will include the following topics:

  • The importance of preventive care and self-care programs
  • The role of medical management in a health plan
  • How medical management is used in different types of care
  • Strategies for managing complex individual cases
  • The role of medical management in providing pharmacy services
  • How and why a delegation is used in medical management
  • How medical management is used to deliver Medicare and Medicaid services
  • Disease management-its purpose, processes, and programs
  • Quality management methods-measurement and improvement

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

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AHIP AHM-540 Exam Syllabus Topics:

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

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