The goal of this course is to equip nurses with knowledge of utilization management as it applies to various payer types and models in the acute care setting.

After taking this course, you should be able to:

Describe the evolution of various payers under managed care.
Explain the various types of managed care models.
Discuss government and other payer models.

This course is FREE with Unlimited CE!

Choose from two Unlimited CE subscription options and get access to 750+ CE and professional development courses.

Get access starting at $49.95/yr

Goal and Learning Outcomes

Managed care began as a solution to growing healthcare costs and poor quality. Various models of healthcare delivery and payment emerged under managed care, but none were maximally efficient or effective in reducing healthcare costs. In 2019, national healthcare expenditures (NHE) consumed 17.7% of the gross domestic product (GDP), which equates to $3.8 trillion (Harrill & Melon, 2021). This course details the evolution of managed care and its payer models. Military payers and other models of healthcare payment are also discussed.

Course Authors

Shalla Newton

MSN, RN, NE-BC

Cathryn Ayers

RN, MSN

Teresa Treiger

MA, RN-BC, CCM, CHCQM, FABQUARP

Accreditation Information

NURSES

In support of improving patient care, Relias LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Provider approved by the California Board of Registered Nursing, CEP#13791

CEBroker

Relias LLC reports to CEBroker for the following boards (Provider # 50-1489): Arkansas State Board Of Nursing, District Of Columbia Board Of Nursing, Florida Board Of Nursing, Georgia Board Of Nursing, New Mexico Board Of Nursing, South Carolina Board Of Nursing and West Virginia Board Of Examiners For Registered Professional Nurses

Please check the licenses/certifications section under my account (after logging in) to make sure you have entered a valid license number. This information is required for correct reporting of your course completions to CE Broker.

Disclosures

None of the planners/faculty, unless otherwise noted, for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Log-in to view

Your Account.

Browse

Nurse.com

Utilization Management: Payers