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  • Total Questions: 163
  • Updated on: Oct 03, 2026
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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.

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:

  • Quality management methods-measurement and improvement
  • How medical management is used in different types of care
  • The role of medical management in providing pharmacy services
  • How and why a delegation is used in medical management
  • 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
  • The role of medical management in a health plan
  • Disease management-its purpose, processes, and programs

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

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AHIP AHM-540 Exam Syllabus Topics:

SectionObjectives
Topic 1: Medical Management Across Care Settings- 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
          - Medical management for government-sponsored programs
          • 1. Medicare
            • 2. Medicaid
              • 3. Other government-sponsored programs
                Topic 2: 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
                          Topic 3: The Medical Management Function- Relationship of medical management to other health plan functions
                          • 1. Legal affairs
                            • 2. Finance
                              • 3. Claims administration
                                • 4. Information management and technology
                                  • 5. Network management
                                    • 6. Risk management
                                      • 7. Sales and marketing
                                        - Environmental influences on medical management
                                        • 1. Federal and state regulatory requirements
                                          • 2. Purchaser, provider, and member expectations
                                            • 3. Impact of environmental factors on delegation
                                              • 4. Accreditation organizations and standards
                                                - 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
                                                        Topic 4: Preventive and Care Management Programs- Disease management
                                                        • 1. Population health management
                                                          • 2. Chronic disease programs
                                                            - Preventive care and self-care programs
                                                            • 1. Member education and wellness
                                                              • 2. Health promotion initiatives
                                                                - Utilization management
                                                                • 1. Medical necessity review
                                                                  • 2. Authorization and utilization review processes
                                                                    - Case management
                                                                    • 1. Care coordination
                                                                      • 2. Management of complex cases

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