Courses Subjects
QUALITY HEALTH MANAGEMENT TRAINING
| No | Healthcare Quality |
| 1 | Healthcare Quality Concepts |
| 2 | The "Quality Resource Center" |
| 3 | The role of healthcare quality professional |
| 4 | Systems under the umbrella of quality management |
| 5 | Quality structure in healthcare organization |
| 6 | Process variation |
| 7 | Change management |
| 8 | The basics of healthcare failure mode and effect analysis |
|
No |
Strategic leadership |
|
1 |
Management and leadership |
|
2 |
Strategic leadership |
|
3 |
Education, training |
|
4 |
Communication |
QUALITY HEALTH MANAGEMENT TRAINING
| No | Performance and improvement |
|
1 |
Performance measurement and improvement |
|
2 |
Risk management |
|
3 |
Patient safety |
|
4 |
Blood and blood component use |
|
5 |
Surgical and procedure case review |
|
6 |
Peer review |
|
7 |
Mortality review |
|
8 |
Medication usage review |
|
9 |
Surveillance, prevention, and control of infection |
|
10 |
Medical record review |
|
11 |
Utilization review |
|
12 |
Quality reviews |
|
13 |
Utilization management |
|
14 |
Care coordination |
|
15 |
Clinical process improvement |
|
16 |
Performance improvement approach |
|
17 |
Performance improvement tools |
|
18 |
Information management |
| NO | Quality Statistics |
| 1 | Epidemiology and statistics |
| 2 | Quality measurement |
| 3 | Data collection |
QUALITY HEALTH MANAGEMENT TRAINING
| No | Accreditation |
| 1 | Integration |
| 2 | Integrated delivery systems |
| 3 | Medical staff credentialing |
| 4 | Accreditation survey process |
| 5 | How accreditation improves quality of care and patient outcomes |
Health Insurance Training Topics
| No | Topics | Lectures |
| 1 | Introduction to medical insurance |
An introduction to medical insurance. The insurance industry. Basic insurance terms. Types of organisation. |
| 2 | Medical expenses |
Medical expense coverage Group/ Individual. Exclusion and limitation. Deductible coinsurance and overall maximums. Reimbursement method. |
| 3 | Insurance contract |
The insurance contract. Legal principal of health insurance contracts. Contract renewal and revision. |
| 4 | Provision of medical expenses | Provision of (group/ individual) medical expense insurance. |
| 5 | Administration of health insurance |
The administration of group health insurance plans. Third-party administration TPA. Instillation polices. Renewal or non-renewal. Premium billing and payment. The grace period, termination, and reinstatement. |
| 6 |
Claim administration. |
Claim administration. Claim processing, Claim investigations. Hospital audit. Costumer services. |
| 7 |
Marketing & Sales of health insurance products. |
Sales of (group/ individual) health insurance products Commissions, Broker fees Bonuses for insurance employees. Marketing of (group/ individual) health insurance products Product research and development. Strategic marketing. Sales and distribution. After the sale customer services |
| 8 | Controlling cost in health insurance | Controlling operational costs, marketing sales, insurance costs, underwriting costs, claim processing costs |
| 9 |
Pricing health insurance products |
Pricing health insurance products Claims, reserve, margin, expenses, profit, investment income. |
| 10 |
Underwriting of health insurance. |
Underwriting of (group/ individual) health insurance. Principle of underwriting. Declining to offer coverage. Information resource for group underwriting. Analysing information. Risk selection factors. Underwriting management |
| 11 | Reinsurance |
Reinsurance and reinsurers. Works and advantage. |
| 12 |
The regulation of the insurance. |
The regulation of the insurance. The regulatory environment of insurance. Insurer compliance with lows and regulations. |
| 13 |
Health care fraud. |
Health care fraud. Managed care fraud. The insurer anti-fraud program. Detection investigation litigation. Files and records. Interviews and surveillance. Evidence and reporting. Consumers and providers, government, agencies, other insurances. Lows against health care fraud Internal action, Civil, Criminal litigation. Legal issues affecting antifraud activities. Antifraud compliance. |
| 14 |
Supplemental health insurance. |
Supplemental health insurance. Hospital indemnity insurance. Illness coverage. Accidental coverage. Dental benefits. Vision care benefits. Long-term care insurance. Disability income coverage Historical disability - residual disability. Limitation Background |
| 15 | Managed health care |
Types of Managed Care Organization Integrated Health Care Delivery System Network Management and Reimbursement Management of Medical Utilization and Quality Internal Operations |