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Last Updated: Jul 25, 2026

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AHM-540 Exam topics

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  • The role of medical management in a health plan
  • Strategies for managing complex individual cases
  • 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
  • How and why a delegation is used in medical management
  • How medical management is used in different types of care
  • The role of medical management in providing pharmacy services
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The price of the AHM-540 exam is 220 USD for AHIP members and 280 USD for non-members.

Who should take the AHM-540 exam

  • Medical management employees working in hospitals, health systems, and, health insurance plans
  • Agents and brokers who expert in life and health insurance
  • Financial executives working with clients looking to maximize their health dollars
  • Employees who work for health care providers or health insurance plans and want to get the educational background to proceed with a management position in the industry
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  • Case administrators and medical directors who inquire a broader administrative background

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

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AHIP AHM-540 Exam Syllabus Topics:

SectionObjectives
Regulatory and Ethical Considerations- Compliance in medical management
- Member rights and confidentiality
Care Management and Coordination- Disease management programs
- Transitions of care
- Case management principles
Utilization Management- Concurrent and retrospective review
- Medical necessity review
- Preauthorization and precertification processes
Quality Management and Improvement- Quality measurement and reporting
- Performance improvement strategies
Introduction to Medical Management- Concepts and objectives of medical management
- Role of medical management in health plans
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