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Health Care Governance Paper

Health Care Governance Paper

Select an existing health care organization and interview one to two different levels of stakeholders. Prepare a paper explaining how each interviewee influences governance within the scope of the organization's management plan. Different level of stakeholders include but not limited to: senior management, directors, employees, staff members, and customers.

Health Care Governance Paper

(1) Describe the health care organization such as the type of facility and the size of the organization.

(2) Describe your interviewees' positions and what level they are in.

(3) Explain each interviewee's influent on the governance.

I started the paper I will add comments to the size of the organization. I am interviewing a R.N. we are both having problems with the question of how she influences goverance within the scope of the organization's management. she is working in the utlization management dept as a prior authoization review nurse. She reviews referals for medical necessity. For example if a women needed a hysterectomy there are cetain medical criterias that she must use to approve the surgery.

I am copying what I have written so far and submitting it. I don't think there is a way for me to send it as an attachment. Please provide references.

~ PAPER~

Molina Health care came about in the 1980's when managed care was flourishing. Dr. Molina had a dream that all people regardless of color, creed or financial background should receive quality health care, which was affordable to low-income patients. He recruited doctors, nurses, specialists, and other ancillary services to join him. The organization is committed to keeping the focus on the member. Molina is a physician-owned and managed health plans which employee's physicians, nurses, and other ancillary departments.

The organization had no clue what was to lie ahead for them. Molina has health plans in California, Indiana, Michigan, New Mexico, Utah, Washington, and San Diego. San Diego came aboard in July 2005 with more than 30,000 members added to the organization. Molina has 21 primary care clinics located in Northern and Southern California. Molina services Medi-cal, Healthy Families, CCS, and Aim. Molina has also added the new Advantage Plan for Medicare part D for their dual insured members.

Molina is uniquely developed to allow for clinical and administrative expertise, resulting in a team that provides strategic direction and is accountable for results for the organization. The organization is dedicated to developing the best possible mode of care for there members. After founder Dr. David Molina died in 1996 his son Dr. John Molina assumed leadership at Molina Healthcare.

I interviewed a new member to our team. She has been a nurse for 30 years. I stated she was new because she was just recently hired. Most of her experience is in managed care. She resigned from Care First another health plan last year due to physical reasons. Her definition of goveranace as she stated " to ensure efficient execution, guidance, and oversight.

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Health Care Governance Paper

(1) Describe the health care organization such as the type of facility and the size of the organization.
Molina Healthcare, Inc. operates as a multi state managed care organization that arranges for the delivery of health care services. The company offers its services to persons eligible to receive health care benefits through government-sponsored programs for low-income families and individuals, such as Medicaid and the State Children's Health Insurance Program. It arranges health care services for members enrolled in health plans through contracts with health care providers that include its clinics, independent physicians and groups, hospitals, and ancillary providers. The company has health plans in California, Washington, Michigan, Utah, New Mexico, and Indiana that are administered by its health maintenance organization-licensed subsidiaries. It also operates 21 company-owned primary care clinics in California, as of December 31, 2004. Molina Healthcare was founded by C. David Molina in 1980. The company was formerly known as American Family Care, Inc. and changed its name to Molina Healthcare, Inc. in 2000. Molina Healthcare, Inc. is headquartered in Long Beach, California

(2) Describe your interviewees' positions and what level they are in.

Prior authorization review nurse: Her role is to review referrals for medical necessity. She has a strong influence on the utilization management of the facility. Her discretionary role is important because she reviews the treatment prescribed to patients. For example if a patient is prescribed hysterectomy and if she finds that sufficient medical criteria have not been met, she may turn down the request for the operation.

The second person that may be interviewed is under the category of senior management and directors. The person is Dr. J. Mario Molina M.D., 47, Chairman, Chief Exec Officer and President. He ...

Solution Summary

Health Care Governance Paper is guided.

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