Managed Care

Masters Degree in Case Management

CSM 600

Breyer State University
Instructor: Mary Lyn Page, RN, MSN

SYLLABUS

COURSE OVERVIEW: This course is designed to provide an overview of managed care, medical management, and regulatory and legal issues. The course work will include the study of managed care organizations, managed care myths, care management, managing basic medical-surgical utilization, clinical services requiring authorization, case management, legal liabilities related to medical management activities, and state regulations. After successful completion of the course, the student will possess practical knowledge and an understanding of managed care processes.

This course is a graduate level course and is formatted to be self-directed. As your instructor, I am available for one-on-one consultation. Methods of communication between us can be via email and telephone appointments. The course completion time limit follows the university’s policy of not less than four weeks and not to exceed ten weeks.

Course work required for successful completion is comprised of weekly assignments and one exam. The text readings form the basis to complete the weekly assignments and the final exam.

TIME FRAME: This is a five-semester hour course. This course is allotted ten weeks of time. You must complete all of the requirements for the course successfully by the end of the ten-week period. The first day of week one will begin the day that you register for the course, or the day that you notify me that your textbooks have arrived and you are ready to begin your studies. Please be cognizant of the time frame. It is rare that extensions of time are permitted, unless you have good justification. Upon successful completion of this course, you will be awarded five semester hours of credit.  

TEXTBOOKS: The following textbook is required for this course.

Book 1: Essentials of managed health care (4th ed.) .Kongstvedt, P. (Ed.). Gaithersburg, MD: Aspen Publishers, Inc: 2001. ISBN # 076372579x.

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GRADING SCALE: You will receive a letter grade based on your overall achievement. The grading scale is as follows:

90–100%    = A
80–89%      = B
70–79%      = C
Below 70%  = Fail

COMMUNICATION: Best way to reach me is by e-mail. Otherwise you can make an appointment for a phone conference.

ABOUT YOUR INSTRUCTOR: Currently, medical case manager for Zurich American Insurance. Other positions have included staff nurse at several NYC hospitals, utilization review, hospital bill auditing, and staff development for case management organizations. I have a BSN from Skidmore College and an MSN from the University of Phoenix. My present position requires working closely with injured workers and their families throughout rehabilitation and recovery with assistance in job accommodation upon referral from insurance carriers.

TECHNOLOGY ISSUES: Weekly assignments are to be submitted via e-mail or fax. These written assignments should be brief, bullet point type answers. If e-mail is selected, assignments should be sent as an attachment in MS Word format. If you use another word processing program, please use the "Save As" option to save the document in MS Word format. If for some reason you cannot save as a Word document, you may save it as "Rich Text Format" (RTF). If fax is chosen, include a cover sheet with your name, # of pages, assignment week #, and instructions for returning your assignment.

COURSE OBJECTIVES: Upon completion of this course, you will be able to:

1). Understand the evolution of managed care.
2). Understand current trends in managed care including market dynamics and public policy.
3). Understand different types of managed care organizations.
4). Identify common misconceptions about managed care.
5). Understand the components and objectives of advanced care management.
6). Understand the basic categories of medical-surgical utilization management.
7). Understand authorization systems and how they are used.
8). Understand the basic objectives and basic activities of case management.
9). Understand the primary drivers of health care consumerism.
10). Understand the legal liability related to medical management activities.
11). Understand how various managed care organizations are regulated by state agencies.

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