Course Code: REL-ACU-0-UMPMO
Hours: 1
Type: Online Course
Content Expiration Date: 12/31/2028
Learning Objectives:
Describe the evolution of various payers under managed care.
Identify the various types of managed care models.
Outline:
Introduction
What Is Managed Care?
Knowledge Check
Key Takeaways
Section 2: Managed Care Payers
HMOs
Integrated Delivery System
Accountable Care Organizations
Patient-Centered Medical Home (PCMH)
PPO
Vertical Integration
Accreditation of MCOs
Member Processes
Knowledge Check
Key Takeaways
Section 3: Government and Other Payers
Government Payers
Other Payer Models
Knowledge Check
Key Takeaways
Section 4: Conclusion
Course Summary
Course Contributors
Resources
References
Exam and BrainSparks
Subject Matter Expert: Quierra Rodriguez, MSN-Ed, APRN, WHNP-BC
Quierra Rodriguez, MSN-Ed, APRN, WHNP-BC, has many years of experience as a utilization management nurse. She’s worked for both payers and payees in utilization review and case management. She is passionate about access to care and the appropriate allocation of healthcare resources. Quierra is the owner of The Nurse’s Quill, a written healthcare content company.
Writer: Sooa Devereaux, MSN, RN
Sooa Devereaux, MSN, RN, has a long history of professional development experience within the hospital setting. She has taught in pre-licensure nursing programs and has mentored many nurses, both new graduate and experienced, throughout her career as a nurse educator. Sooa is a Lead SME Writer at Relias and holds an MSN in Nursing Education.
Target Audience:
The target audience for this course is: Care and Case Managers; Nursing Personnel; in the following settings: Ambulatory Care, Hospitals: Acute, Hospitals: Critical Access (CAHs).
Relias Learning will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Relias Learning has a grievance policy in place to facilitate reports of dissatisfaction. Relias Learning will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias Learning at support@reliaslearning.com.
All courses offered by Relias Learning, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.