Structure and Governance

Description

Building the Guardrails: Managed Care Governance & Policy

Regulators and accrediting bodies are prescriptive about managed care committee responsibilities and governance policy language. Join TMG in exploring the necessary governance structure needed to successfully navigate the managed care landscape.

Objectives:
Explain committee structure, responsibilities, and authorizations in the managed care environment
Identify 4 provisions that must be included in managed care governance documents
Describe 5 required managed care procedures for proper documentation and decision making

Completing the Puzzle: Who’s Who in Managed Care Credentialing

It’s crucial to have a solid grasp of the basics before diving into the deeper issues surrounding managed care credentialing. Join TMG in exploring the roles and responsibilities of stakeholders in managed care and how the pieces of managed care fit together.

Objectives:
Identify the regulatory and accreditation bodies that oversee managed care
Explain the types of organizations that are accredited by CMS, NCQA, and URAC
Describe which environments perform credentialing under CMS, NCQA, and URAC standards