About this Learning Activity

Network Management 301: Advanced - Lessons from NCQA Surveys

Through this learning activity, health plan professionals and their partners are guided through critical practices for network management. More specifically, this surveyor-led online course equips professionals with insight into low performing standards specific to Network Management. The course includes examples and lessons learned to help participants define, plan, and achieve excellence in network management. By completing this course, professionals will have clear direction on where to focus their operational efforts.

Key Topics:

• Availability of Practitioners
• Assessment of Network Adequacy

What You Will Learn

• Identify the most frequent pitfalls observed by NCQA surveyors
• Implement practices that align with target outcomes
• Describe documentation that demonstrates compliance to standard requirements
• Recognize opportunities for policy, procedure, or documentation adjustments.

Who Should Attend

• Clinicians, directors, managers, specialists, and coordinators who contribute to provide network operations
• Consultants, contractors, delegates, and vendors of health plans
• Professionals in compliance or risk management
• Professionals in quality assurance/improvement or performance measurement

Faculty

Albert “Irv” Koehler, RN, MBA

Irv Koehler is a health care quality consultant for the Koehler Quality Group, LLC. In this position, he is an NCQA administrative surveyor and provides consulting services to organizations evaluating and preparing for NCQA Accreditation/ Certification projects, risk adjustment validation for managed care organizations, education on quality improvement practices and outcome measure development and tracking. Mr. Koehler is also a registered nurse with active licensure in Florida and Tennessee, and certification in quality and medical coding. Previously, he was a quality improvement professional at AmeriHealth Caritas and BlueCross BlueShield of Tennessee.

Mr. Koehler has an MBA from the Florida Institute of Technology, a BS in Nursing from Florida Southern College, a BA in Psychology and an ADN from Purdue University.

Continuing Education

This live course grants 1.0 required Continuing Education Unit (CEU) points for PCMH Certified Content Experts.

This is a non AMA PRA Category 1 Credit™, ANA CNE, ACPE activity.

* Please note – You must attend the entire program to be eligible for total number of contact hours.

Disclosure of Relevant Financial Relationships

The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.

For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution.  For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.

Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Relevant financial relationships exist with the following companies/organizations:

Faculty:

Albert Koehler: None

Additional Planning Committee Members:

Vince Pereira: None
Julie Pung: None
Tandeece Tubolino: None

This program was developed in part by NCQA staff.

This program received no commercial support.