Health Care Policy and Procedure Resources 2nd Edition Is Available Now

Research and Markets (http://www.researchandmarkets.com/reports/c80827) has announced the addition of “Health Care Job Descriptions for Providers, Medical Directors and Staff Plus Human Relations Policy and Procedure Resources, 2nd Edition (2008 Update)” to their offering.

Medical directors, physician, nurse, nurse practitioner, nurse midwife, anesthetists, physician assistants, utilization management department staff and many other licensed and non-licensed health care job descriptions plus competency, performance improvement, audit or evaluation tools, counselling policy, employee handbook policies including sexual harassment policies – especially applicable to medical groups and managed healthcare organizations.

Preface:

The managed care medical practice environment requires job descriptions to provide a common expectation for the various roles in an efficient, physician-directed, medical care organization committed to cost effective, high quality care that will meet medical office accreditation and related standards. This manual has been developed to assist medical groups and hospitals in the implementation of successful medical management programs, particularly in relation to the delivery of outpatient managed health care services under ‘at risk’ health plan contracts.

The example policies and procedures in other Apollo publications are designed to reduce variation in care, identify model medical management practices tested in other medical groups, and to be consistent with NCQA, JCAHO and other credentialing standards. However, unless the practices described in these documents, following appropriate modification to be consistent with the philosophy, by-laws and management direction of the organization, are actively integrated into the daily activities of each caregiver, the effect will be minimal.

Accreditation organizations require that medical organizations demonstrate an adherence to appropriate policies and procedures that address a specific standard of care for a period of six to 24 months prior to accreditation. Additionally, there must be a demonstrated sequential improvement for measures related to practice improvement. Since survival of the physician’s practice will increasingly be dependent on not only effectively managing care, but also meeting credentialing/accreditation body requirements to be eligible for health plan (HP) contracts, there is a great incentive to focus on performance improvement techniques.

One of the reasons for the development of the Manual is to provide a model to assist the medical organization’s providers in collaboratively making any necessary changes in practice operations to become more effective and efficient or to develop increased value through improving quality while managing costs. A stable and collegial work environment is an expectation. Any practice is successful only to the extent that individuals select us to provide their needed health care services.

The health plans, partners in the delivery of managed care, are increasingly concerned that each contracted provider, whether a hospital, medical group or IPA meet standards that will permit, in turn, their accreditation by either NCQA or JCAHO.

Contents:

Preface

Table of Contents

Introduction — a ‘must read’

Thirteen Commandments for a satisfying medical practice

Thoughts for the Day

Job Descriptions for Health Care Providers

Medical Director

PHO Medical Director

Quality Assurance/Management Medical Director

Managed Care Organization Medical Director or Chief Medical Officer

Health Plan Medical Director for Appeals and Grievances (New 11-04)

Physician Advisor (update 10-05)

Other Medical Directors/Physician Advisors

LTC/SNF Medical Directors (new 2-06)

Primary Physician — job description, work standards

Medical Record Audit

Physician Work Standards — Additional considerations

Mentor Policy

Primary Physician Coordinated Care Policy

Physician staffing requirements (New 11-06)

Office Visits, Primary Physician, by Diagnosis

Obstacles to effective medical practice

Hospitalists *

Physician Extenders/Non-physician Clinicians

Physicians Assistant (added 1-04)

Nurse Midwife (added 1-04, update 7-05)

Licensed Vocational Nurse/Licensed Practical Nurse (LVN/LPN) (added 7-05)

Registered Nurse (added 7-05, update 9-06)

-Charge nurse (New 9-06)

Nurse Practitioner/Advanced Practice Nurses (added 7-05)

Nurse Practitioner/Physician Assistant Endoscopists (added 7-05)

JCAHO Standard for privileges listing for NPs and PAs (added 7-05)

Nursing web sites (added 7-05)

Nursing Practice Standards (New 6-05)

Utilization/Quality Management Dept.

Clinical Director, Utilization Management (update 9-06)

Regional Utilization Manager — job description, performance appraisal

Utilization Management, Managed Care Coordinator/Representative

UM Nurse Reviewer

Concurrent Review Nurse Coordinator

Denial Letter Administrative Assistant

Managed Care Technicians

Pharmaceutical Benefits Director

Quality assurance nurse

Utilization/Resource Management Staff — Training and Job Standards

Utilization/Resource Management — Reviewer Evaluation

For more information visit http://www.researchandmarkets.com/reports/c80827.