NU 504 - Managed Care

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.