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Pages:
1 page/β‰ˆ275 words
Sources:
2 Sources
Style:
APA
Subject:
Health, Medicine, Nursing
Type:
Essay
Language:
English (U.S.)
Document:
MS Word
Date:
Total cost:
$ 4.32
Topic:

Role of Healthcare Organizations on Risk Management Policies and MCOs Standard Compliance

Essay Instructions:

Throughout this course, you have identified, examined, and provided individual as well as collaborative analysis on multiple facets of risk management in the health care setting.
Addressing the knowledge you have gained, and building on that knowledge to add your evaluation of the role that the managed care organization (MCO) plays in today's health care environment, develop a 250-500 word reflection to incorporate the following:
What is a health care organization's administrative role regarding oversight of risk management policies and ensuring compliance with managed care organization (MCOs) standards?
What is your assessment of the value provided to an organization that stems from the regulatory statutes of a typical MCO? Consider the establishment of conflict resolution and risk management strategies within the health care organization from the employer/employee perspective as well as in regards to patient conflict circumstances.
What MCO responsibilities pertain to the Patient Protection and Affordable Care Act (PPACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Essay Sample Content Preview:

Reflective Analysis
Name of Student
Institutional Affiliation
Reflective Analysis
The administrative roles of healthcare organizations vary in nature and usually include the creation and communication of goals and strategies. However, with regards to risk management policies and compliance with the standards set by managed care organizations (MCOs), these roles often include the development of policies and programs aimed at engaging the public and relevant stakeholders in decision-making. Healthcare organizations also have to partake in the development of contracts and awarding of practitioner contracts depending on the level of quality required. Failure to meet the quality standards by practitioners is punished by termination of contracts. Similarly, healthcare organizations have to monitor and ensure compliance with MCO standards among the staff, as well as by managements and health programs.
The regulatory statutes of a typical MCO adds value in terms of risk management and conflict resolutions thorough its appeals and grievance policies. MCO appeals and grievance policies allow patients or members of an MCO to submit grievances, complaints, and request the MCO to act upon certain decisions or agre...
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