Learn the managed care process and how to ethically initiate and maintain an insurance-based practice

Presentation-style

  • Course Description

    This presentation will inform listeners about the basics of working in a Managed Care Environment. Listeners will learn information about managed care policies to help them develop protocols and processes to thrive in an insurance payer system of care; the ethical and legal consequences of inadequate insurance protocols will be highlighted. Providers will learn an 'insider perspective' about how to navigate the insurance system efficiently and effectively, in terms of issues like rate negotiations and the utilization of specific billing codes.

  • Learning Objectives

    Upon completing this course, participants will be able to: Describe how providers become empaneled (a participating provider) with insurance companies; Describe one or more legal and ethical consequences of using incorrect billing codes


    Target Audience and Instructional Level
    This course is intended for psychologists, therapists, social workers, clinical counselors, and addiction counselors. Instructional level: Introductory

  • How To Take This Course

    In order to receive a certificate of completion reflecting the associated CE credit hour, you must:
    #1: Have an active Clearly Clinical membership
    #2: Listen to the corresponding course podcast
    #3: Achieve a passing grade on the post-presentation test (the test has up to ten questions and you must earn a score of at least 80%; you are able to re-test)
    #4: Complete the requested course evaluation.

    Course requirements (including the course audio, post-test, and course evaluation) can be completed on a computer or mobile device via your Clearly Clinical account.

  • Course Format

    This high-quality and interesting course contains a one-hour, non-interactive audio podcast presentation which is available for free via Apple Podcasts, Google Play, or your other favorite podcast providers. You can also listen to and download the file via our course player.

  • Commercial Support

    There is no known commercial support or conflict of interest for this CE program, presenter, sponsor, instructor, or content.

  • Certificate Access Details

    Once you've completed the course, your certificate will automatically populate in the 'Certificate' section of your account; it will also be emailed to you. Access to completion certificate will expire 365 days after issuance. Course certificates will be on file for ten (10) years from date of course completion.

  • Accommodations

    If you have special needs or need an accommodation, please email us at info@clearlyclinical.com and we will do our best to assist you.

Instructor

Tenured Insurance Executive

David Nefussy

Senior Instructor

David Nefussy is Spectrum Health’s Vice President of Business Development. He previously served as the regional director of provider network services for MA, ME, NH, RI and VT at OPTUM Health, otherwise known as United Behavioral Health (UBH) where he was responsible for contracting and provider relations. Prior to UBH, he worked in a similar capacity for PacifiCare, Magellan, Beacon Health Strategies, Harvard Pilgrim Health Care and Private Health Care Systems. In addition, he's worked with several committees around behavioral health/primary care integration, 2013 CPT Code changes and federal mental health parity, including the Massachusetts Association of Health Plans, Massachusetts Division of Insurance, Association of Behavioral Health and Massachusetts Association of Behavioral Health Systems.

See why we're the country's premier CE provider

  • CONVENIENT: All courses are 1-hour podcast episodes, available on Apple Podcasts, GooglePlay, and many others

  • AFFORDABLE: We offer quality CE courses through a reasonably-priced membership

  • SOCIALLY-RESPONSIBLE: We donate to The Trevor Project for LGBT youth suicide prevention

  • WOMEN-OWNED: We are founded and run by Elizabeth Irias, LMFT

  • DIVERSE: We highlight minority expert presenters


Quick Note: Are you confused about the difference between a Continuing Education Unit (CEU) and a Continuing Education (CE) Credit Hour?  You're not the only one! Visit our Frequently Asked Questions page for clarification!