Health Plan
IPA/Medical Group
Restricted Knox Keene licensed governance structure
Board of directors/managers accountability
Reporting in areas of:
finance
compliance operations
Strategy and planning
Market and line of business analysis
Product development
Sales and marketing
Proforma development
Profit and loss management
Institutional and Professional capitation management
Institutional and Professional IBNR calculations
Utilization cost management
Shared risk pool management
Provider and Payer contracting
Enrollment/Eligibility
Provider relations
Claims payment
Utilization management
Quality management
Care management
Patient/Member call center operations
All aspects of regulatory filing and reporting for the Department of Managed Health Care, Centers for Medicare and Medicaid Services, and the Department of Health Care Services for:
Full-service health plans inclusive of:
New applications
Geographic expansions
Transactions
Risk Bearing IPAs, Medical Groups, and Restricted Knox Keene Licensed entities in California:
Operational oversight and monitoring and reporting regulatory compliance
Full scope operations and financial audits:
Department of Managed Health Care
Centers for Medicare and Medicaid Services
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