The health care organization’s administrative role is to oversee the daily activities and ensure that there is quality care and service administered to patients. The health care manager is tasked with the responsibilities of ensuring that all clinical and administrative processes are completed. By monitoring the clinical and administrative procedures, the health care manager ensures that the risk management policies are implemented and employees adhere to the managed care organization standards. According to Lewis et al. (2019), health care organization administrative develops policies and programs that the staff and other stakeholders have to base their decision-making on. The health care manager clearly communicates the identified risks and preventive measures to the staff, and makes sure that all employees are informed of their responsibilities.
The regulatory statues of MCO assist health care organizations in implementing quality control measures. Marton et al. (2014) affirm that the regulatory systems of MCO ensure that employers and employees take accountability when delivering health care services to patients. As a result, the regulatory statues are used to ensure that patients have access to quality care and can launch complaints when they do not receive effective services. The MCO’s policies are applied as fundamental guidelines that inform the practices for conflict resolution and risk management by influencing how patients and employees interact with each other.
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MCO responsibilities are to ensure that patients have access to affordable care and quality services. Therefore, to prevent fraud, waste and abuse of law in health care institutions, the organization ensures that all staff strictly adheres to the health care policies stipulated to guide them in practice (Caswel & Long, 2015). MCO take legal action against health care facilities that fail to uphold their policies as well as promote quality care and services.
References
Caswel, K. & Long, S. (2015). The Expanding Role of Managed Care in the Medicaid Program: Implications for Health Care Access, Use, and Expenditures for Nonelderly Adults. The Journal of Healthcare Organization . Retrieved from: https://doi.org/10.1177/0046958015575524
Lewis, V. A., Schoenherr, K., Fraze, T., & Cunningham, A. (2019). Clinical coordination in accountable care organizations: A qualitative study. Health care management review , 44 (2), 127–136. doi:10.1097/HMR.0000000000000141
Marton, J., Yelowitz, A., & Talbert, J. C. (2014). A tale of two cities? The heterogeneous impact of Medicaid managed care. Journal of health economics , 36 , 47-68.
