Nursing 42 Clinical Views

Managed Care Organizations

Clinical Requirement:

See attachment RiskmanagementWk5Instructions.docx Reflect on and evaluate the role that the managed care organization (MCO) plays in today's health care environment by developing a 750-1,000-word response that addresses the following: · Explain what a health care organization's administrative role is in executing risk management policies and ensuring compliance with managed care organization (MCO) standards. · Explain what value the regulatory statutes of a typical MCO provide to a health care organization and include strategies pertaining to policies such as conflict resolution and risk management that affect patients and families as well as employees and employers.  · Explain what MCO responsibilities relevant to the Patient Protection and Affordable Care Act (ACA) and Centers for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws. · Identify strategies that can be implemented for developing a culture of reporting and transparency.
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