A Nurses Introduction to Managed Care exam 2022

What is Managed Care? - method of healthcare delivery designed to provide the highest quality of care at the most cost effective means available. Why was the managed care system developed? - response to dramatic increases in healthcare costs resulting from the explosion of new medical technology and treatments How are HC services provided under managed care? - through a contracted methodology of payment What's the purpose of using a contracted methodology of payment? - means of controlling unnecessary costs through UM of med and pharmacy serv and treatments through evaluation and monitoring techniques What is the purpose of eval & monitoring? - to curb fraud, waste, & abuse Role of nurse has grown in managed care to include new skills, such as: - Finance, collaboration, ins reimbursement, computer technology, critical thinking and leadership What are some recent growth opportunities for nurses? - Research, ds and wellness mgmt.