Healthcare Management-An Introduction

Course Overview

As health care professionals work to make health care better, more efficient, and more affordable, health care management has emerged as one of our industry’s most valuable tools. AHIP’s Healthcare Management: An Introduction (AHM250) online course will help you better-serve your members and clients by strengthening your understanding of the management principles transforming health care.

Learning Objectives

What You’ll Learn

  • Gain a practical understanding of the evolution of health care delivery and financing in the United States, 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

Who Should Take This Course

  • Agents and brokers
  • Case managers
  • Financial planners
  • Health insurance provider staff
  • Medical directors
  • Medical management staff

Module 1: Healthcare Management: An Introduction (AHM250)

Module 2: Evolution of Health Plans

Module 3: Basic Concepts of Health Insurance

Module 4: Health Plan Benefits and Networks

Module 5: Provider Compensation Fee-for-Service to Value-Based Care

Module 6: The Health Maintenance Organization (HMO)

Module 7: Types of HMOs and ACO Basics

Module 8: PPOs and other Health Plan Types

Module 9: Health Plans for Specialty Services

Module 10: Consumer-Directed Health Plans Part I

Module 11: Consumer- Directed Health Plans Part II

Module 12: Provider Organizations an Compensation Modules

Module 13: Network Structure and Management

Module 14: Utilization Management

Module 15: Utilization Review

Module 16: Quality Assessment and Improvement

Module 17: Quality Standards, Accreditation, and Performance Measures

Module 18: Marketing

Module 19: Underwriting, Rating, and Plan Funding

Module 20: Information Management

Module 21: Claims Administration

Module 22: Member Services

Module 23: Federal Laws and Regulation

Module 24: The Affordable Care Act

Module 25: State Laws and Regulation

Module 26: Government Programs: Medicare

Module 27: Government Programs: Medicaid

Module 28: Ethics

Price: $435

This Course includes:

   Text-based content

   5 weeks