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Optum Health Care Executive Summary

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A system in Optum’s organizational culture is the complex, detailed work in a fast-paced claims review department metrics, processing a minimum of eighty claims per day. Although Optum has a quality assurance review of whether the case management department addresses the value drivers: right care, right providers, right medications, right lifestyle, and depression screening, a quality assurance review of claims processing including the measurement of member’s satisfaction with their claims processing has not been instituted. To improve member safety and quality of care, communication, collaboration, and commitment must be the cornerstone for a positive organizational outcomes (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014). As a nurse leader at Optum, suggesting strategies to achieve quality and safety improvement in health care requires critical thinking, analysis of health care trends, and collaborative relationships (Grossman & Valiga, 2012). This collaborative professional relationship requires a blame-free environment for a successful safety culture (Agency for Healthcare Research and Quality [AHRQ], 2016). As Optum strives to …show more content…

(2016). AARQ views. Retrieved from http://ahrq.gov/news/blog/ahrqviews/comparing-health-systems.html Agency for Healthcare Research and Quality website. (2017). https://psnet.ahrq.gov Grossman, S. C., & Valiga, T. M. (2012). The new leadership challenge: Creating the future of nursing (4th ed.). [Proquest Ebook Central]. Retrieved from http://ebookcentral.proquest.com Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishmnet of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing, 11(1), 5-15.

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