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2350.00
103
Fellow, Academy for Healthcare Management Designation
Course Overview
This impressive career credential positions you as a seasoned healthcare management professional versant in a range of specialties, including care management, financial management, network development, maintenance strategies, medical policies, governance, policy trends, and more.
Required Courses
- Healthcare Management: An introduction (AHM250)
- Governance, Legal Issues, Medicare and Medicaid (AHM510)
- Health Plan Finance and Risk Management (AHM520)
- Network Management (AHM530)
- Medical Management (AHM540)
Learning Objectives
Achieving this designation demonstrates to your colleagues, partners, and clients that you have a strong commitment to the industry and your organization’s success.
Download Course BrochureModule 1: Healthcare Management: An Introduction (AHM250)
Gain a practical understanding of the evolution of health care delivery and financing from pre-paid plans to ACOs
Understand the basic concepts of health insurance provider organizations
Distinguish among HMOs, PPOs, POSs, and managed indemnity
Recognize HSAs' and HRAs' roles in today's consumer-centric environment
Identify different types of health insurance provider organizations
Learn the importance of network structure and management in delivering quality healthcare
Examine the interplay of information technology with essential functions of health insurance provider operations
Explore the concepts of rating, underwriting, and claims administration in health insurance provider environments
Delve into legislative and regulatory issues affecting the health insurance industry, including the Affordable Care Act (ACA) and the 21st Century Cures Act
Understand role of government-sponsored programs, including Medicare and Medicaid, in providing coverage to large segments of the population
Review relevant terms, industry issues, care scenarios, and concepts
Module 2: Governance, Legal Issues, Medicare & Medicaid (AHM510)
Explore factors shaping the health insurance industry, its formation, types of insurance, and structure
Understand how health insurance providers use reorganization, reengineering, and strategic planning to improve performance
Examine legal issues faced by health insurance providers in a post-reform environment
Understand the legal issues surrounding ERISA, pharmacy benefits, and wellness
Delve into federal and state regulatory requirements that affect health insurance providers
Learn the role of the federal government as a purchaser of health care benefits
Dig deep into the role of health insurance providers in providing services to both Medicare and Medicaid enrollees
Analyze how fraud and abuse affect health care's cost and quality
Explore how health insurance providers use organizational control systems to build internal structures that meet external demands for accountability
Review relevant terms, industry issues, case scenarios and concepts
Module 3: Health Plan Finance and Risk Management (AHM520)
Analyze the role of strategic financial planning in setting a health insurance provider's future direction
Gain an understanding of risk, decisions regarding risk assumption, and how health insurance providers control risk
Compare the difference between stop-loss insurance and stop-loss reinsurance from the perspective of health insurance providers
Learn about the financial risks for health insurance provider organizations that provide health care services to Medicare and/or Medicaid populations compared to risks within the commercial population
Distinguish between fully funded and self-funded plans and the increasing role of self-funding in the marketplace
Discover how to identify claim related components of health insurance providers' financial statements
Recognize different reserving methodologies used by health insurance providers
Module 4: Network Management (AHM530)
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
Module 5: Medical Management (AHM540)
Understand role of medical management in health insurance provider organizations
Identify how and why a delegation is used in medical management
Examine the role of medical management in providing pharmacy services
Recognize the importance of preventive care and self-care programs
Explore strategies for managing complex individual cases
Understand disease management-its purpose, processes, and programs
Learn how medical management is used in different types of care
Quality management methods-measurement and improvements
Recognize how medical management is used to deliver Medicare and Medicaid services
