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Courses Subjects

    QUALITY HEALTH MANAGEMENT TRAINING  

 No  Healthcare  Quality   
1 Healthcare  Quality Concepts  
2 The "Quality Resource Center"
The role of healthcare quality professional
4 Systems under the umbrella of quality management
5 Quality structure  in healthcare organization
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

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