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AHIP AHM-540

AHM-540

Exam Code: AHM-540

Exam Name: Medical Management

Updated: Aug 27, 2026

Q & A: 163 Questions and Answers

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

AHIP AHM-540 Exam Syllabus Topics:

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

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