Question: Discussion Instructions post your response to how Utilization Management, Quality Management, and Accreditation impact how we manage care and Health Insurance organizations using several of

  • Discussion Instructions post your response to how Utilization Management, Quality Management, and Accreditation impact how we manage care and Health Insurance organizations using several of the below concepts in your answers.
    • Recognizing the different approaches to managing wellness and prevention.
    • Identify and describe the basic metrics and measures used to access and monitor medical costs and health plans' utilization.
    • Describe the essential components of utilization management for medical services, including prospective, concurrent, and retrospective reviews.
    • Explain the basic concepts underlying disease management, case management, transition management, and patient-centered medical home.
    • Describe the essential components of Quality Management, including structure, process, and outcomes.
    • Understand the purpose and scope of external review and accreditation of managed care plans.

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