Mar 29, 2023  
2014-2015 Saint Joseph’s College Online 
2014-2015 Saint Joseph’s College Online [Archived Catalog]

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NU 504 - Managed Care

Examines the historical perspective and the emerging philosophy of managed care and its role in the shifting emphasis from illness to prevention and health promotion for diverse groups in the changing health care system. Ethical issues, technology, quality management, client and provider accountability, and risk management will be investigated. Variations in case management models and interdisciplinary approaches will be analyzed

Assignment Overview
Assignments: 4 Units

Interactivity: None

Final Assessment: Final Paper

Course Learning Objectives
Upon completion of this course, you should be able to do the following:

  • Describe the historical and philosophical framework of managed care and its evolution within the US health-care-delivery system.
  • Understand key managed-care terminology (define managed-care terms and abbreviations).
  • Define managed care and compare the major methods of reimbursement and structures used in the delivery and funding of managed-care plans.
  • Compare and contrast the primary types of managed-care plans.
  • Articulate the role of the government as purchaser and regulator of managed care.
  • Analyze the role and responsibilities of the nurse and other health-care professionals on the health-care team in managed-care organizations, and identify potential ethical issues for nurses in these environments, as well as the need for and role of credentialing.
  • Define case management and disease management as applied in managed-care settings.
  • Recognize the role of quality improvement and accreditation within managed-care plans.
  • List the key compliance and regulatory issues, including the Health Insurance Portability and Accountability Act (HIPAA) and other regulations that impact. 

Credits: 3

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