Managed care credentialing of advanced practice nurses

Area of Science:

• Healthcare Administration
• Medical Staffing
• Nursing Practice

Background:

• Rapid changes in healthcare delivery necessitate reevaluation of provider relationships and quality assurance methods.
• Emphasis on systematic credentialing, privileging, and performance evaluation for healthcare providers.
• Managed care systems are evolving, impacting traditional healthcare delivery models.

Purpose of the Study:

• To discuss current and evolving credentialing and privileging processes for physicians in managed care.
• To explore the potential need for expanded credentialing for advanced practice nurses.
• To provide insights into the evolution of credentialing, measurement sources, medicolegal issues, and suggestions for nurse credentialing.

Main Methods:

• Review of existing credentialing and privileging processes for physicians in managed care.
• Analysis of the impact of managed care evolution on advanced practice nurse roles.
• Examination of historical events, current measures, and future suggestions for nurse credentialing.

Main Results:

• Physician credentialing and privileging are established but evolving within managed care.
• Advanced practice nurses may require expanded credentialing processes to align with healthcare system changes.
• A comprehensive credentialing system for nurses can enhance their role in reformed healthcare.

Conclusions:

• Systematic credentialing and privileging are essential for quality and safety in managed care.
• The evolving healthcare landscape necessitates a reevaluation and potential expansion of advanced practice nurse credentialing.
• Enhanced nurse credentialing will support the nursing profession's capacity to contribute significantly to healthcare reform.