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Reference: https://www.ahip.org/courses/network-management-ahm530
| Section | Objectives |
|---|---|
| Network Structure and Design | - Network adequacy and geographic coverage requirements - Network configuration strategies - Types of provider networks (HMO, PPO, POS) |
| Provider Contracting and Reimbursement | - Fee-for-service, capitation, and bundled payments - Contract negotiation and terms - Value-based reimbursement models |
| Utilization and Care Management | - Utilization management tools and techniques - Referral and authorization systems |
| Provider Credentialing and Oversight | - Credentialing and re-credentialing processes - Quality monitoring and performance evaluation |
| Network Performance and Compliance | - Regulatory and accreditation requirements - Network performance metrics |
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