CLINICAL MANAGEMENT AND DATA-DRIVEN DECISION-MAKING

Course Description

This course covers the clinical and operational strategies that bridge the gap between non-technology approaches and full-scale technology deployment. You will study fiduciary PBM partnerships, cost-effective access to care through onsite clinics and telemedicine, medical case management and chronic condition management, and data-driven decision-making for plan optimization. These strategies represent the operational core of plan management, where clinical knowledge, vendor management, and data analytics converge.

Learning Objectives

• Evaluate PBM models and identify fiduciary PBM characteristics.
• Design a cost-effective access to care strategy including onsite clinics and telemedicine.
• Develop a chronic condition management program that reduces high-cost complications.
• Apply data-driven decision-making to plan administration, renewals, and underwriting.
• Explain the role of social determinants of health (SDoH) in plan design.

Estimated Completion Time: 18 hours