Achieving and Maintaining Accreditation in Managed Care

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Achieving and Maintaining Accreditation in Managed Care Accreditation is a process by which an impartial organization (URAC) will review a company’s operations to ensure that the company is conducting business in a manner consistent with national standards. For a physician and a nurse after they receive their degree they have to do continuing education courses every year to maintain their licensing with that particular state. These classes are generally known as CME’s (Continuing medical education). They serve to “maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession” (ACCME). That being said…show more content…
MBHCO accreditation can be earned by proving their proficiency across five standards. Quality management and improvement, where the organization has a process that will monitor, evaluate and improve the quality of safety of the care that is provided. Care coordination, where the organization coordinates the medical and/or behavioral care for its members. Utilization management entails that the organization with let their members and practitioners know about coverage decisions within a required time frame. Credentialing and re-credentialing, being where the organization will check the credentials of the practitioner’s network. Also there is the members’ rights and responsibilities being where the organization has written members’ rights and responsibilities policy. You might wonder why physicians need to have accreditation with managed care facilities and have their licenses at the facilities that they work under. This is a legal matter, being almost the same as you always having your license in any car that you drive. Although the physician may be well known in the community, they have to have their licenses on file in each facility they work under. This is for the facility and well as the physician. Nurses will work under the physician’s license for the managed care, but they also need to have
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