AHIP AHM-540 : Medical Management

AHM-540 real exams

Exam Code: AHM-540

Exam Name: Medical Management

Updated: Sep 03, 2026

Q & A: 163 Questions and Answers

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The benefit in Obtaining the AHM-540 Exam Certification

Candidates can get knowledge and skills that help them to succeed in the rapidly changing and evolving healthcare industry.

  • By passing, AHM-540 exam candidate can add a new dimension to his career experience and distinguish himself as a person who is knowledgeable about the environment, products, operations, and issues of the health insurance plan industry.
  • By passing the AHM-540 exam will give candidates a sense of personal accomplishment and the respect of colleagues in their organization and throughout the industry.
  • By passing in AHM Medical Management AHM-540 Exam, Candidates can be participating in a new and exciting course. Candidate's participation will signify their commitment to professionalism.
  • Candidates can learn unique complexities associated with health plans and being the update in knowledge with the latest trends, developments, and practices.

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

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

What is the duration of the AHM-540 Exam

  • Format: Multiple choices, multiple answers
  • Length of Examination: 120 minutes
  • Number of Questions: 163

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How much AHM-540 Exam Cost

The price of the AHM-540 exam is 220 USD for AHIP members and 280 USD for non-members.

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

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