AHIP Medical Management : AHM-540

  • Exam Code: AHM-540
  • Exam Name: Medical Management
  • Updated: Aug 26, 2026
  • Q&As: 163 Questions and Answers

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AHM-540 Exam Reference

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

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.

AHIP AHM-540 Exam Syllabus Topics:

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

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