Want to buy for someone else? You can purchase a token at check out.
This course is free with a membership upgrade!
Upgrade to a Standard membership and gain access to 1,000+ CE and professional development courses.
Overview
The goal of this course is to equip nurses with knowledge of utilization management as it applies to various payer types and models in the acute care setting.Goals and Learning Outcomes
Managed care began as a solution to growing healthcare costs and poor quality. Various models of healthcare delivery and payment emerged under managed care, but none were maximally efficient or effective in reducing healthcare costs. In 2019, national healthcare expenditures (NHE) consumed 17.7% of the gross domestic product (GDP), which equates to $3.8 trillion (Harrill & Melon, 2021). This course details the evolution of managed care and its payer models. Military payers and other models of healthcare payment are also discussed.
The goal of this course is to equip nurses with knowledge of utilization management as it applies to various payer types and models in the acute care setting.
- Describe the evolution of various payers under managed care.
- Explain the various types of managed care models.
- Discuss government and other payer models.
Course Details
Course Originally Released on : 7/1/2022
Course Expiration Date : 12/31/2025
REL-ACU-0-UMP
Accreditations
NURSES
In support of improving patient care, Relias LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Provider approved by the California Board of Registered Nursing, CEP#13791
Disclaimer: Not all courses will provide California Board of Registered Nursing approval. Per California Assembly Bill No. 241, continuing education courses related to direct patient care shall address at least one or a combination of the following:(1) Examples of how implicit bias affects perceptions and treatment decisions of licensees, leading to disparities in health outcomes; or (2) Strategies to address how unintended biases in decision-making may contribute to health care disparities by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, or other characteristics.
CEBroker
Relias LLC reports to CEBroker for the following boards (Provider # 50-1489): Arkansas State Board Of Nursing, District Of Columbia Board Of Nursing, Florida Board Of Nursing, Georgia Board Of Nursing, New Mexico Board Of Nursing, South Carolina Board Of Nursing and West Virginia Board Of Examiners For Registered Professional Nurses
Please check the licenses/certifications section under my account (after logging in) to make sure you have entered a valid license number. This information is required for correct reporting of your course completions to CE Broker.
Disclosures
None of the planners/faculty, unless otherwise noted, for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
This program has been pre-approved by The Commission for Case Manager Certification to provide continuing education credit to CCM® board certified case managers. The course is approved for 1.00 CE contact hour(s).