Network Management (AHM530)

Learn about the network management function in health insurance plans as this course provides you with insight into both network development strategies (risk management, recruiting, selection and contracting) and network maintenance strategies (managing provider performance and feedback). You’ll also learn about considerations for different types of networks.

What You’ll Learn:

  • The scope and organization of the network management function in health plans
  • Network strategies for access, quality, and cost-effectiveness
  • The process for network provider selection
  • Essential elements of a contractual relationship between health plans and providers
  • The primary responsibilities and obligations of health plans and providers under a provider contract
  • How health plans select, contract with, and compensate specialists and healthcare facilities
  • Special requirements that affect network management for Medicare, Medicaid, and workers’ compensation networks
  • How health plans ensure their provider networks remain adequate to meet member needs

Who Should take this Course:

  • Employees who work for health care providers or health insurance plans and want to acquire the educational background to pursue a management position in the industry
  • Case managers and medical directors who seek a broader administrative background
  • Educators at the college level who teach health care administration
  • Financial planners, and agents and brokers who specialize in life and health insurance
  • Medical management staff working in hospitals, health systems, HMOs, health insurance plans, and PPOs
  • Consumers and others in related fields who seek expertise in this area

Enrollment

$220 AHIP Members; $280 Non-members

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Earn a Designation

This course is good towards earning the following Academy for Healthcare Management designation:

Fellow, Academy for Healthcare Management (FAHM®)

Sponsored by America’s Health Insurance Plans and the Blue Cross Blue Shield Association, AHM relies on both associations’ decades of experience providing continuing education for health insurance plan professionals. AHM serves more than 1,300 health insurance plans caring for and providing coverage to more than 200 million people.