The curriculum incorporates lectures, discussion, and practice exercises organized around four modules that define the foundations of managed care. A Certificate in Managed Care Operations is given to all participants upon completion of the training; CEU credit is offered to nurses. 

Module #1:  Utilization Management

Utilization management is a critical component of managed care because of its central role in approving and denying healthcare services. This module is designed to give participants the following competencies:

  • Learn key regulatory requirements that govern health plan decisions
  • Demonstrate in-depth knowledge of the healthcare authorization process
  • Understand how clinical criteria can support or overturn healthcare authorization decisions
  • Construct tools for ensuring quality in the health service authorization process 
  • Identify discrepancies among operational practice, policies, and regulations 

Module #2:  Quality Management

Quality management (also called quality improvement and quality assurance) in health plans, health systems, and hospitals is charged with ensuring the provision of quality care by physicians and other healthcare professionals. This module is designed to give participants the following competencies:

  • Learn key regulatory requirements that govern quality improvement and management
  • Understand the steps in investigations of potential quality issue and corrective action plans
  • Identify individual cases that may present potential quality issues
  • Construct meaningful quality improvement projects

Module #3:  Grievances and Appeals

Management of enrollees’ grievances, complaints, and appeals is a lens into organizational performance. If a health plan or provider rebuffs or dismisses patient issues or considers them a nuisance, quality of care suffers. This module is designed to give participants the following competencies:   

  • Learn key regulatory requirements that govern patient grievances and appeals
  • Understand the components of a grievance investigation and resolution
  • Identify salient issues generated by the grievances and appeals process 
  • Develop strategies to maximize the positive impact of grievances and appeals on organizational units

Module #4:  Access and Availability

Access to care addresses the obstacles that patients experience in obtaining the services that they have contracted with a health plan to provide. These issues often involve geographic barriers or an insufficient volume and diversity of providers in the plan’s network. Availability of care addresses barriers to a patient’s ability to obtain care from providers as a result of inordinate wait times to schedule appointments, tests and procedures, as well as wait times in providers’ offices. This module is designed to give participants the following competencies: 

  • Learn how data collection tasks produce access and availability regulatory reports
  • Understand California’s Timely Access Regulations (TAR)
  • Identify strategies to improve timely access to care 
  • Evaluate delivery of services based on access and availability standards

Benefits of Academy Training

Participants and their organizations will gain the following benefits from Academy training:

  • A holistic understanding of the components of managed care and how they interact
  • Comprehensive and up-to-date knowledge of regulatory compliance requirements
  • Leverage and positioning in the competitive healthcare climate
  • Tools for professional advancement 
  • Strategies to address regulatory deficiencies and corrective actions
  • Confidence and foresight in preparing for audits and reviews
  • Planning aids to improve individual department and work group performance
  • Knowledge and skills to instruct other professionals based on Academy curriculum
  • Expertise for use in marketing and other promotional activities

Course Schedule

Classes are in-residence and limited to 10 participants. The course requires a 32-hour commitment, scheduled over two weekend sessions, two weeks apart. Parking and lunches are included. Hotel accommodations adjacent to the conference venue are available at participant expense.  

Application Process

The Academy conducts an individualized selection process based on an evaluation of a candidate’s background and goals and how these factors align with the curriculum.  Minimum requirements are three years of healthcare experience and a bachelor’s degree. Final candidates will participate in personal or telephone interviews with Academy faculty members. To begin, please submit the attached application via this link:


Tuition is inclusive of parking, materials, and lunches. Hotel accommodations adjacent to the conference venue are available at participant expense.

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