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Medical Management
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AHIP AHM-540 Questions and Answers
The case management team at the Hightower Health Plan reviewed the medical records of the following two plan members to determine the type of care each one needs and the most appropriate setting for that care:
Ira Morton was hospitalized for a severe stroke. Although his medical condition is stable, the stroke left him partially paralyzed and he will require extensive rehabilitation and 24-hour medical care.
Theresa Finley is recovering from a total hip replacement and is in need of short-term physical therapy and twice-weekly visits from a licensed nurse to check her blood pressure and the healing of her incision.
From the answer choices below, select the response that correctly identifies the level of care that would be most appropriate for Mr. Morton and Ms. Finley.
MCOs usually have a formal program for the oversight of delegated activities. The following statements concern typical delegation oversight programs. Select the answer choice containing the correct statement.
The paragraph below contains two pairs of terms enclosed in parentheses. Select the term in each pair that correctly completes the paragraph. Then select the answer choice containing the two terms that you have chosen.
Under a delegation arrangement, the (delegate / delegator) is responsible for performing the delegated function according to established standards, and the (delegate / delegator) is ultimately accountable for any deficiencies in the performance of the function.
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It’s a professional credential that covers key principles of healthcare delivery, cost control, and quality management.
Healthcare managers, insurance professionals, and clinical leaders aiming to improve care efficiency should take it.
It ensures patients receive coordinated, effective, and affordable care within healthcare systems.
To enhance patient outcomes, reduce costs, and maintain high-quality standards in healthcare.
It strengthens professional credibility and opens advancement opportunities in managed care and health plans.
Medical management oversees system-wide care, while case management focuses on individual patient needs.
Balancing patient needs, cost containment, and fairness are common ethical challenges.
Roles like medical manager, health plan analyst, and quality assurance coordinator benefit most.
It provides coordinated, timely, and personalized care that improves patient trust and comfort.
Healthcare Management: An Introduction
Governance and Regulation
Health Plan Finance and Risk Management
Network Management
Using this AHIP AHM-540 guide helped me quickly understand complex medical management concepts and feel confident during the exam.
TESTED 01 Dec 2025
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