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Collaborating with key functional areas to improve managed Medicaid compliance

Gerard B. Niewenhous (gniewenhous_126@q.com) is Founder and Principal, Niewenhous Health Solutions, a strategic consulting firm in Plymouth, MN.

Medicaid is highly regulated. Federal and state regulations and requirements stipulate that Medicaid Managed Care Organizations (MCOs) maintain a program to ensure compliance. Although the responsibility for compliance rests with the compliance officer, fidelity with federal and state regulations and requirements cannot be achieved without the active collaboration of key functional areas that are subject to oversight.

This article explores the basis for collaboration with a key functional area, using operations as an example. The article goes on to provide actionable strategies and tactics for creating a collaboration and improving compliance using Kotter’s eight-stage change management model[1] as the method.

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