Course Overview
Organizations that make network management a priority are better positioned to provide high quality, value-focused care, while maintaining financial sustainability. The Network Management (AHM530) online course is a deep dive into how health insurance providers leverage the network management function to seamlessly integrate health care providers, clinics, hospitals, pharmacies, and other essential stakeholders
What You’ll Learn
- Gain a detailed understanding of the scope and organization of the network management function within health insurance provider organizations
- Understand how network strategies improve access, quality, and cost-effectiveness
- Learn the process for network provider selection
- Master the essential elements of a contractual relationship between health insurance providers and health care providers
- Identify the primary responsibilities and obligations of health insurance providers and health care providers under a provider contract
- Map out how health insurance providers select, contract with, and compensate specialists and health care facilities
- Recognize special requirements that affect network management for Medicare, Medicaid, and workers’ compensation networks
- Explore how health insurance providers ensure their provider networks remain adequate to meet member needs
Who Should Take This Course
- Agents and brokers
- Case managers
- Financial planners
- Health insurance provider staff
- Medical directors
- Medical management staff