Common use of Care Coordinators Clause in Contracts

Care Coordinators. Each Enrollee identified as requiring Care Management Services and those who agree will be assigned a Care Coordinator. Care Coordinators assigned to Enrollees with varying risk levels shall have their overall caseload weighted and a blended overall caseload limit set, taking into account the location of the Enrollee. Contractor will provide the Department with its methodology for assigning Enrollees with varying risk levels for Prior Approval. The Department may review existing caseloads at any time and require a change in methodology or an Enrollee’s assignment to a caseload. Caseloads of Care Coordinators shall not exceed the following standards:

Care Coordinators. Each Enrollee identified as requiring Care Management Services and those who agree will be assigned a Care CoordinatorCoordinator as part of the Enrollee’s Integrated Care Team. Care Coordinators assigned to Enrollees with varying risk levels shall have their overall caseload weighted and a blended overall caseload case load limit set, taking into account the location of the Enrollee. Contractor will provide the Department with its methodology for assigning Enrollees with varying risk levels for Prior Approval. The Department may review existing caseloads at any time and require a change in methodology or an Enrollee’s assignment to a caseload. Caseloads Case loads of Care Coordinators shall not exceed the following standards, on average, during a calendar year: