This conference has concluded.

Utilization Management:

Addressing Crucial Challenges for Health Plans

Leading-Edge Strategies to Manage Costs and Boost Care Quality

September 26-27, 2019
AC Hotel by Marriott Downtown | Nashville, TN

Join us in Nashville this September for a deep-dive look at how innovative health plans are leveraging the latest tools and strategies to achieve their UM and care management goals.

Top professionals will reveal how they are staying on top of challenges including:

The variety of new options for care in diverse settings (including observation and in-home care),
Renewed pressure from the AMA to reform prior authorizations,
And the rise of genetic testing to become the fastest growing area of lab spend.

Don’t miss this unique opportunity to learn how leading experts are rethinking and refining their UM work to
optimize effectiveness and member satisfaction.

Key topics will include

Special Workshop: Genetic Test Utilization Management and the Trend toward Precision Medicine
The Growing Prior Authorization Reform Movement and Recent PA Innovations

Spotlight Discussion Panel: Optimal Development of UM Clinical Guidelines
Leveraging the Latest Technologies and Analytics Strategies for Optimizing UM and Improving Care Quality
Featured Session: Optimally Managing In-Patient Hospitalization

Evaluating New Options in Observation and Coordinated Home Care as an Alternative to or Following Acute Care
Effectively Analyzing Your Appeals Outcomes to Enhance UM Accuracy

Who will you meet?

  • Network with and learn alongside fellow professionals from Medicare Advantage, Medicaid and commercial health plans specializing in the following areas:
  • Utilization management/utilization review
  • Chief Medical Officer/Medical Directors
  • Case/care management
  • Compliance
  • Appeals
  • Quality Improvement
  • IT/data exchange/electronic health records (EHR)
  • Analytics
  • Healthcare services/health services
  • Network management/provider relations
  • Member relations
  • Accreditation
  • Operations

How Will This Conference Help You?

Learn how UM professionals are more effectively collaborating with hospitals to better manage in-patient stays and prevent readmission

Hear about the AMA’s growing movement to reform prior authorization and the latest innovations which are streamlining PA

Get information on new developments in observation and in-home care alternatives
Gain insights on managing genetic testing, the fastest growing area of lab spend, and learn how to prepare for the future of genetics-based Precision Medicine
Understand how to leverage the latest technologies and analytics strategies to optimize UM and improve care quality
Take a new look at UM productivity metrics and ensuring adequate UM staffing
Learn how to better analyze your appeals outcomes to enhance UM accuracy
Evaluate external options to boost your plan’s UM effectiveness

In addition, professionals from healthcare provider organizations and hospitals are welcome to round out the discussion of optimizing UM collaboration.

  • “Extremely informative. Enjoyed the perspectives, lessons learned and best practices from many plans and consulting groups.”

    Julie Donaghey, Director of UM Program Oversight, Member Appeals & Grievances

    BMC HealthNet Plan

  • “Content was on point. The attendees added incredible perspective to the discussion. The right people were in the room.”

    Harold Hilty, Director of Appeals and Grievances


  • “Interesting speakers who provided great insight and experience from a broad range of companies.”

    Kate Salveson, Manager Grievance and Appeals

    Quartz Health Solutions

  • “Topics covered and breakout sessions were valuable.”

    Destiny Gordon, Operations Manager, MA Appeals & Grievances

    Blue Cross Blue Shield Tennessee

  • “Content for the majority of sessions and the variety of plans represented in the speaker panels was very good.”

    Karen Longo, Director, Medicare Advantage Operations

    Harvard Pilgrim Health Care

  • “The topics were very informative. It gave me a chance to see that my company isn’t the only one with appeals and grievance issues.”

    Kimberly Butler, Manager of Claims Resolution and Oversight



Scott Howell, DO, MA, MPH&TM, CPE, MBA

Chief Medical Officer

Gwen Fraley, MS, CGC

Director, Clinical Policy

Nishi Goel

PharmD, VP of Product Management & Strategy

Kelly Athman, MS, CGC

Director, Utilization Management Review

Mark Green, MBA,PMP, LSSBB

VP Care Transitions

John Broderick, MD

Chief Clinical Officer—East

Claudia Ellison

Senior Director Of Programs

Sunil Budhrani MD, MPH, MBA

Chief Executive Officer/Chief Medical Officer

Debra Jacobs

Assistant Vice President of Utilization Management, Clinical Operations, Appeals & Grievances

Daniel DeSantis, MBA

Manager, Clinical Programs and Evaluation

Danielle Phelps Swartz, RN, BSN, CCM

Senior Director, Care Coordination and Integration

Lori Dove, MSN, MHA

VP Post-Acute Services

Eric Cannon

AVP Pharmacy Benefit Services

Dave Griffith

Manager, Pharmacy Operations



September 2019


  • 7:15 AM

    Conference Registration & Networking Breakfast

  • 8:15 AM

    Conference Sessions:

    • - Welcome and Opening Remarks
    • - Special Workshop: Genetic Test Utilization Management and the Movement toward Precision Medicine
  • 10:30 AM

    Networking Break

  • 10:45 AM

    Conference Sessions

    • - Optimal Development of UM Clinical Guidelines
  • 11:30 AM

    Extended Networking Luncheon

  • 12:45 PM

    Conference Sessions

    • Special 2-Part Feature: Prior Authorization
      - Understanding the Movement to Reform Prior Authorization, and the Developments So Far
    • - Innovations in Prior Authorization
  • 2:45 PM

    Networking Break

  • 3:15 PM

    Conference Sessions

    • - Leveraging the Latest Technologies and Analytics Strategies for Optimizing Utilization Management and Improving Care Quality
  • 4:00 PM

    Networking Roundtable Discussions

  • 4:45 PM

    Networking Cocktail Reception

  • 5:45 PM

    End of Day


September 2019


  • 8:00 AM

    Networking Breakfast

  • 9:00 AM

    Conference Sessions:

    • - Chairperson’s Welcome Back
    • Featured Session: Health Plans and Hospitals - Strategies for Success in Collaborating to Preventing Hospital Readmissions
  • 10:10 AM

    Networking Break

  • 10:30 AM

    Conference Sessions

    • - Incorporating New Options in Observation and Coordinated Home Care as an Alternative to or Following Acute Care
    • Special Feature: Effectively Analyzing Your Appeals Outcomes to Enhance UM Accuracy
  • 12:15 PM

    Networking Luncheon

  • 1:15 PM

    Conference Sessions

    • - Hospital Perspective: Strategies for Optimal Payer/Provider Collaboration to Manage In-Patient Hospitalization
    • - Understanding Productivity Metrics and Ensuring Adequate UM Staffing
  • 2:30 PM

    Conference Concludes



AC Hotel by Marriott Nashville Downtown

410 5th Ave S
Nashville, TN 37203
(615) 682-0260

The new AC Hotel by Marriott Nashville Downtown is located across the street from the Music City Center & steps from the Country Music Hall of Fame, Bridgestone Arena & the famed Lower Broadway area featuring restaurants and classic Nashville music clubs. The hotel includes an outdoor pool & bar on the 6th floor, as well as a fitness center & three unique options for dining.

SmarterTravel has named Nashville as one of the 10 best U.S. cities to visit in 2019.  They point out that “no matter when you go or what time of year, there’s always good music.”  For example, you might want to take in the “Opry Country Classics” Review show at the historic Ryman Auditorium on the Thursday night of the conference  (just a short walk from the AC Hotel). Or find your favorite musician’s star on the nearby Music City Walk of Fame.

Hotel MdR

IEN has negotiated a special room rate of $269/night. The venue is only offering this rate until September 3, 2019, so please book early.  Once the room block sells out, pricing and availability will be at the venue’s discretion.  Call 615-514-2500 and mention the Insight Exchange Network conference to reserve your room.  Alternatively, you can click this link to reserve online.

Additional rooms have been reserved at Springhill Suites which is in the same building as the AC Hotel. These rooms are at $269/night and are expected to go fast. For this rate, call (888) 263-2427 with group code "ISEC" or use this website to book.

Sponsor Or Exhibit At This Event

  • This field is for validation purposes and should be left unchanged.

Insight Exchange Network
P.O. Box 3867
Santa Cruz, CA 95062
(831) 431-6668
[email protected]
Privacy Policy


Website by WebHolism