Critical Thinking Training Instructional Matrix

Learning Objectives

Topics

Module 1 :
Upon completing this
module the trainee will be
able to:

WC 101
- Common Workers
Compensation
Terminologies
Basic UR/UM overview
UR Workflow End to End
process explained
- Utilization Review
- Utilization review process
- Definition of terms
- UR determinations
- Review types
- Prior authorization
- Required preauthorization list
- CA UR Forms (with
samples)
- Timing of
submission/receipt of RFA
Overview of the Mandatory
GLs for CA UR
Request Requirements
CA UR Turn-around times
LOI Process
Physician Reviewer
Requirements
Negotiated Approvals vs
Modified Approvals
Required Notifications on

-Identify common Workers

Compensation
terminologies
-Understand Utilization
Review and general UR
thinking
-In depth understanding of
Utilization Review

Module 2:
Upon completing this
module the trainee will be
able to:
-Focus UR training to
understand CA state
regulations and
requirements

Day/
s

3
days

Methodology/Str
ategy
(including
logistics and
materials)
Lecture-Discussion
InteractiveDiscussion
PowerPoint (PPT)
Presentation

Evaluation/
Measures

Post test
Ungraded
recitation (Q&A)

Manual/Textbooks

Learning Outcome

-Develop understanding of
Workers Compensation and
impact of Utilization Review
-Strengthen Utilization Review
concepts and role identification
-Understand UR timing of
submission and impact in case
processing

Video Presentation
Role-play

2
days

Lecture-Discussion
InteractiveDiscussion
PowerPoint (PPT)
Presentation
Manual/Textbooks
Video presentation

Post test
Ungraded
recitation (Q&A)

-Identify UR state requirements

-Learn and implement protocol
for processing requests
-Learn to troubleshoot cases
that do not meet criteria
-Understand case turn-around
times and case prioritization
-When to incorporate Lack of
Information Process and
importance in proceeding with

Module 3:
Upon completing this
module the trainee will be
able to:
-Construct clinical
summary
-Concretize UR concepts
and sample application
Module 4 :
Upon completing this
module, the trainee will
be able to:
- Be familiarized and
navigate ACOEM
- Perform UR proper
utilizing ACOEM for
guideline citation and
decision making
- Be familiarized and
navigate MTUS
- Perform UR proper
utilizing CA MTUS and
ACOEM for guideline
citation and decision
making
Module 5 :
Upon completing this
module, the trainee will
be able to:
- Be familiarized and
navigate ODG
- Perform UR proper
utilizing ODG for guideline
citation and decision

Approvals and Adverse

Determinations
Reconsideration Process
Dispute Resolution (IMR
Process)
Forms
UR Nurse Activity
- How to make a clinical
summary (HOC)
Admin Activity
- Identification of UR request
- Identification of
workability and
completeness of
information for case entry

Medical Guidelines
CA MTUS
Chronic Pain Medical
Treatment Guidelines
CA MTUS Acupuncture
Medical Treatment Guidelines
ACOEM
- Post-surgical Treatment
- Rehabilitation

case

1 day

Mini-prod
Activity

Post-exam on CA
UR
Ungraded
recitation (Q&A)

2
days

Lecture-Discussion
InteractiveDiscussion
PowerPoint (PPT)
Presentation
Workshops of
accomplishing
forms

Ungraded
recitation (Q&A)
Guideline citation
exercise

-Practical application of
Utilization Review concepts and
role identification
-Develop critical thinking

-Knowledge of Utilization
review and CA MTUS navigation
and usage
-Guideline Identification and
guided decision-making

Manual/Textbooks
Activity on HOC
and correct
citation
Mock review
Medical Guidelines
ODG
ODG Good to Go! (Self- training
module)

1 day

Lecture-Discussion
InteractiveDiscussion
PowerPoint (PPT)
Presentation
Manual/Textbooks

Ungraded
recitation (Q&A)
Guideline citation
exercise
Graded mock UR
cases

-Knowledge of ACOEM, usage,

basis as UR decision making
and integration with ODG
-Incorporate clinical judgment
into processing UR case

making

Module 6 :
Upon completing this
module, the trainee will
be able to:
-Consolidate all topics into
practical work application
- Perform UR proper
integrating ODG and
ACOEM with MTUS in
performing UR for
guideline citation and
decision making

Guideline citation
exercise
-CA UR case entry
-CA UR Initial Clinical Review

1 day

Mock review
Mock review

Graded mock UR
cases

-Implement all protocols from

previous
topics
through
practical application
-Test recall and critical thinking
skills