Essentials of Managed Health Care
HCA 320 Essentials of Managed Health Care
3 Semester Units
Essentials of Managed Health Care focuses on health insurance as it impacts the management of healthcare organizations. This course provides a systematic overview of the history of managed healthcare and health insurance in the United States, types of health plans and available payers, the provider network, utilization management, quality management, accreditation, Medicare Advantage, Medicaid managed care, and laws and regulations in health insurance and managed care.
Upon successful completion of this course, students will be able to:
- Discuss the major forces shaping health insurance and managed care today.
- Outline the basic types of health insurers and managed care organizations.
- Identify the basic elements of risk-based and non-risk-based provider payment.
- Describe the basic components of utilization management for medical services.
- Identify the basic elements of the internal operations of payer organizations.
- Explain the Medicare and Medicaid benefit structures.
- Identify key state and federal laws and regulations governing managed care.
If you are interested in taking this course, please explore a degree or certificate program below:> Explore Health Care Administration Programs
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