Healthcare Services : A Healthcare Specialist

1262 Words Oct 7th, 2015 6 Pages
Managed care is a healthcare specialist brought together to deliver services to improve quality and costs. The main functions are assembling, bringing together providers to deliver services, evaluating suppliers, and services. The normal way providers are paid for services, managed care users per diem, per case and per capita. Managed care combines health insurance, care and administration.
The Health care system is hospitals, physicians and other providers that provide other, health care services. All these include independent practices, third party, managed services and doctor-hospital organizations. Managed care contracts are essential to manage the finances of an organization and keep their records and to negotiate contracts, but to be able to make a profit. The more an organization can control its finances is essential to pay providers.
Utilization review is when health insurance companies and providers and hospitals discuss whether treatment is medically necessary for a patient or patients which usually done after treatment or services. Utilization reviews evaluate the efficiency of the health care services, procedures and providers. All treatments must meet the citer of the review. Health insurance companies must follow state laws, which each state is different.
Most utilization reviews are standard practice. These are meant to control costs and keep unnecessary treatment and treatment procedures and procedures at a minimum. Quality assurance is keeping a level of…
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