The Internal Organization Of Managed Care Organizations Essay

The Internal Organization Of Managed Care Organizations Essay

Length: 1017 words (2.9 double-spaced pages)

Rating: Better Essays

Open Document

Essay Preview

As the managed care organizations continues to expand, and as the affordable care is taking root in the United States. The country in its entirety relies on managed care to assure access, manage costs and provide comprehensive services. Hence, it is imperative that the Managed care departments work in Unisom to achieve optimal health care for their customers. Therefore it is important to analyze and understand the internal organization of managed care organizations (MCOs).
The internal operation of a typical managed care organization consists of the following:
Marketing and sales department
Enrollment and billing
Claims administration
Member services
And underwriting
Information technology
Marketing and sales department
Starting with the executives of MCOs, their major functions include assembling and maintaining networks of providers to deliver services, overseeing the marketing those services as a health plan, assist in supplying financial services (including processing claims), and evaluate services. These administrative functions may all exist within a single organization, or they may be provided through separate organizations or combinations of organizations.
The key to successful administrative processes within a managed care organization is a well-coordinated workflow and excellent administrative leadership. Therefore, at the core of the managed care organizations’ services are their clients, therefore are no clients available to buy their products there will be no MCO. To achieve this goal the marketing departments within a managed care organization (MCO) creates a strategy for easily navigating the health insurance market while building infrastructure to sell the MCO’s services or products ...

... middle of paper ...

... payment process preferred by the individual health care providers. Finally, the information is achieved for reference purposes.
Overall, the functions of the claims department require collaboration with other departments within the organization to succeed; because their functions, if well executed could impact the financial status of the MCO, likewise, the activities of other departments may influences or affect the duties of the claims department.
Member services
The member services department is vital to the MCO’s organization since they interface between the members of the organization and all the departments within the organization. The member service department with the assistance of the other departments provides general information to their member, routinely communicate with members about the new policy change, and provide proactive outreach to members.

Need Writing Help?

Get feedback on grammar, clarity, concision and logic instantly.

Check your paper »

Benefits Of Integrated Managed Care Essay

- Integrated Managed Care Organization- The organization is properly aligned for the primary driver being cost cutting services. Since all entities within the organization are responsible and affected by any expenses endured on any entity being unfavorable or favorable, the foundation serves as a primary motivator to reduce costs at all levels. This alignment eliminates any financial gains from driving high utilization of services or higher intensity services within the organization. Ultimately, this system allows the physician medical group to drive patient care, being responsible for the clinical care decisions as opposed to health plan making those decisions as designed in other organi...   [tags: Health care, Health insurance, Managed care]

Better Essays
957 words (2.7 pages)

Tqm : An Organization As A Organization Essay

- ... Customers are becoming increasingly aware of rising standards, having access to wide range of products and services to choose from. There is an ever-increasing demand for quality product and/or services and this global revolution had forced organizations to invest substantial resources in adopting and implementing total quality management strategies. Total quality management can be summarized as a management system for a customer-focused organization that involves all employees in continual improvement....   [tags: Strategic management, Organization, Management]

Better Essays
951 words (2.7 pages)

Lifelong Learning For Organizations: Managing Inclusiveness and Growth Essay

- Lifelong learning, as a concept, has recently received a lot of attention. It has, however, been viewed largely in the context of individuals and as to how they need to continuously learn and evolve in a knowledge economy. The concept places value on flexible learning strategies, multidisciplinary and flexible approaches to curricula, and up gradation of skills to respond to the demands generated by the external environment. The external environment, however, effects not only individuals but the organizations as well....   [tags: knowledge, lifelong learning, organizations]

Better Essays
2576 words (7.4 pages)

Managed Care Essay

- Managed Care Introduction Surprisingly, U.S. managed care has been in existence for almost a century. In 1910, the Western Clinic of Tacoma, Washington offered medical services through its network of doctors and nurses for the premium payment of $0.50 per member per month. Nearly one hundred years later, managed care organizations (MCOs) have changed dramatically with increased complexity and significance to the U.S. healthcare market. Aggregate revenues for MCOs in the S&P 500 index grew 30% in 2006 to $212.4 billion while earnings per share estimates are expected to increase by 15% for 2007....   [tags: Healthcare Managed Care]

Better Essays
1832 words (5.2 pages)

Organizational Culture Of Organization And Its Employees Essay

- Every organization has its own culture that plays an important role in shaping the behavior of the organization and its employees. One definition of organizational culture states it is “the values and behaviors that contribute to the unique social and psychological environment of an organization” including “the organization’s expectations, experiences, philosophy, and values that hold it together” (Organizational Culture, 2015). Basically, organizational culture is the combination of a company’s “attitudes, beliefs, customs, and written and unwritten rules that have been developed over time and are considered valid” (Organizational Culture, 2015)....   [tags: Organizational studies, Organization]

Better Essays
1475 words (4.2 pages)

How Politics And Communication Within An Organization Essay

- Are great leaders born or created. This is one subject that has been greatly debated over the years, and there is no right or wrong answer. There is evidence that certain personality traits are more inclined to leadership, such as extroverts. “Leadership describes the dynamic social and relational influence process of understanding the situation and facilitating individual and collective efforts to accomplish shared goals” (Ramthun, 2015). Whether born or created, great leaders make things happen and help shape future leaders....   [tags: Management, Leadership, Organization, Employment]

Better Essays
1277 words (3.6 pages)

Essay about Why Organization Is Effective For Effective Communication

- If the organization is effective in communicating then the employees are aware and they are able to consciously decide how to feel and act, based on facts. Minter (2010) stated that there are seven competencies in communication that should be audited periodically to assess communication health, they include: Influence, feedback effectiveness, permissiveness, responsiveness, interdependence, reward for communicating, and trust (p. 109). The article discussed organizational communication audits that companies can use to ensure that healthy communication is ongoing....   [tags: Ethics, Organization, Business ethics, Morality]

Better Essays
1655 words (4.7 pages)

Different Views of the Comparison Between Non-profit and For Profit Organizations

- Want to just say no to taxes and not pay them. Then create a not for profit organization and be exempted from all income taxes within that organization. Some examples of non-profit organizations are: hospitals, universities, political parties, religious organizations, and research for scientific studies. While on the other hand, for profit companies are any business that is owned by a person or a group of people. Some examples of for profit organizations are the following: private health organizations, product organizations, transport organizations, and many more (Haddad, n.d.)....   [tags: non-profit organization, ]

Better Essays
1428 words (4.1 pages)

Essay on How Leadership Approaches Towards Organization Change Within Healthcare

- Approaches to Organizational Change (Moving to an Accountable Care Organization) Many healthcare organizations across American are transitioning to a newer healthcare delivery model referred to as accountable care organizations, (ACOs) (Dunkelberger, J. 2015). Financially, this means the organizations are moving from a “getting paid more for doing more” model towards a model that delivers a better value, yet acknowledging a risk-bearing component (Dunkelberger, J. 2015). The success of this delivery model is determined by a healthcare organization’s ability to evoke change not only within its members, but to change the patient’s role in obtaining optimal health....   [tags: Health care, Management, Managed care, Illness]

Better Essays
1015 words (2.9 pages)

Nonprofit Organizations Essays

- Nonprofit Organizations I. Introduction: Why do Nonprofit organizations exist and what do they do. II. Planning in Nonprofit organizations 1. The importance of planning 2. Steps in planning a. setting goals b. identifying the needs of those whom the goals will serve c. developing and defining specific role and mission of organization d. specific organizational objectives e. setting priorities f. measuring results III. Budgeting Nonprofit organizations 1. Importance of budgeting 2....   [tags: Papers Not for Profit Business Essays]

Better Essays
2061 words (5.9 pages)