For RNs to navigate successfully within the current health care environment, it is critical that they know and understand the provisions and limitations of managed care, including the regulatory framework. Such knowledge can enhance nurses' performance in their roles as patient advocates, health promoters, and proactive leaders in the managed health care industry. Unfortunately, many nurses report unfamiliarity with such regulations and much of their knowledge is learned through on-the-job experience rather through formal academic preparation.
The Texas Department of Insurance (TDI), in cooperation with the Texas Nurses Association (TNA) obtained a $150,000 grant from the Foundation for Insurance Regulatory Studies in Texas (FIRST) to develop an integrated program. Under the FIRST grant and in cooperation with TNA, the TDI HMO Quality Assurance Section has hired five graduate nurse interns. The interns work under the supervision of one of the full-time RNs on staff at TDI. The purpose of the program is to provide an exchange of information between state policy-makers, TDI staff and managers, and interns regarding managed care issues.
In their roles as interns, the graduate RNs have participated in a variety of activities. The interns have been actively involved in rule development work groups which include background research and responding to comments from the industry. One nurse intern developed automated exam tools, which are utilized by TDI examiners in reviewing HMOs and have also been made available on TDI's website for HMOs to conduct self-audits. The exams database will also allow TDI to track compliance over time.
Learning Objectives: Learning Objectives: At the conclusion of the session, the participant will be able to: · Describe the role of the graduate RN in a managed care regulatory environment. Teaching Objectives: · During the session, the speaker will discuss the history of Registered Nurses in a managed care regulatory environment. · During the session, the speaker will present the history of the FIRST grant, its goals, objectives, and evaluation. · During the session, the speaker will discuss the role of the graduate nurse intern in a managed care regulatory environment.
Keywords: Managed Care, Interns
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.