Portland Community College | Portland, Oregon

Students who successfully complete this course will be able to:
 

1. Ensure compliance with standard guidelines, policy and procedures and updates.
2. Understand how to monitor systems, through risk assessment, severity of illness/intensity of service and utilization review.
3. Validate timeliness of data and data sources within local and external systems.
4. Understand how to perform audits and investigate reasons for reimbursement denials.
5. Design and conduct quality assessment and performance studies by being able to retrieve data
6. from patient records, create reports, identifying data sources and results.
7. Create patient care and physician performance profiles in accordance with regulatory and
8. accreditation standards.
9. Use quality improvement tools and techniques to improve clinical processes.
10. Retrieve data from patient records and report results of utilization and resource management
11. studies.
12. Analyze clinical data to identify trends. Use trends to evaluate enterprise performance.
13. Conduct investigation of the causes and under- and over-utilization of patient care resources.
14. Å·ÖÞ±­¾öÈü¾º²Âapp_Å·ÖÞ±­×ãÇòÍø-Ͷע|¹ÙÍø and maintain the enterprise’s utilization and resource management and risk
15. management polices and procedures.
16. Retrieve data from patient records and report results of risk management studies.
17. Identify, investigate and report potentially compensable events and patient care incidents.
18. Retrieve data from patient records for the development of practice guidelines, clinical paths,
19. clinical algorithms or critical paths. Assist in the development and maintenance for same.
20. Organize and manage the critical path and case management activities of the enterprise.
21. Know how to differentiate between and appropriately use research methodologies and present
22. them in articles, papers or presentations.
23. Understand and recognize when to use data presentation techniques. Use data presentation
24. techniques appropriately in charts and graphs and other statistical information and reports.
25. Apply and interpret results of benchmarking data and create reports.
26. Prepare and deliver presentations clearly, concisely with good communication and
27. delivery techniques.
28. Attend and participate in a committee meeting. Take notes and type minutes in a professional,
29. readable and accurate format.

Students will demonstrate these learning outcomes by these tasks conducted individually and in cooperation with other students:

1.  Answer theoretical and application questions on information covered in the lecture, graded assignment and reading assignments.
2.  Complete a variety of work assignments to demonstrate understanding of basic concepts.
3.  Be able to work on a group project and communicate project to remainder of class.
4.   Demonstrate ability to appropriately prepare and edit written communications and medical reports.

Subject Matter, Concepts, Themes, Issues:
The following list outlines the concepts, themes and issues you need to understand and be able to use appropriately. You will have the opportunity to demonstrate your understanding in written and oral form, individually and in groups. See attached.