Key Staff Requirements Sample Clauses
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Key Staff Requirements. The MCO’s Key Staff must also meet the following requirements, as applicable:
1. The Chief Executive Officer/Chief Operating Officer (CEO/COO) shall serve in a full time (40 hours per week) position available during BMS business hours to fulfill the responsibilities of the position and to oversee the entire operation of the MCO. The CEO/COO shall devote sufficient time to the MCO’s operations to ensure adherence to program requirements and timely responses to BMS. The CEO/COO shall be authorized and empowered to make contractual, operational, and financial decisions for the contract, related to business, claims payment, provider relations/contracting, and all other functions of the MCO. The CEO/COO must be directly employed by the MCO. The CEO/▇▇▇ must attend in person, upon BMS request, meetings, and hearings of legislative committees, interested governmental bodies, agencies, and officers. The CEO/▇▇▇ must establish and maintain positive client relationships, make contractual, operational, and financial decisions on behalf of the MCO, and oversee and provider overarching contract oversight for the MCO. The CEO/COO must have at least ten (10) years’ experience in Medicaid managed care oversight and operations, ten (10) years’ experience in healthcare administration and operations, a bachelor’s degree or higher and be based in West Virginia.
2. The Contract Liaison/MHT Administrator is responsible for overall delivery of the project, serving as a liaison with BMS during all phases of the contract. The Administrator must attend in person, upon BMS request, meeting and hearings of legislative committees and interested governmental bodies, agencies, and officers. The Administrator must maintain a positive client relationship, provide timely and informed responses to operational and administrative inquires that arise, meet with BMS staff or such other persons as designated by BMS on a regular basis to provide oral and written status reports and other information as required. The Administrator must respond to issues involving information systems and reporting, appeals, quality improvement, member services, service management, pharmacy management, medical management, and care coordination. The Administrator must ensure that each member has an ongoing source of care appropriate to his or her needs and a person or entity formally designated as primarily responsible for coordinating the services accessed by the member, per 42 CFR §438.208(b)(1). The Administrator m...
Key Staff Requirements. The MCO’s Key Staff must also meet the following requirements, as applicable:
1. The Chief Executive Officer/Chief Operating Officer (CEO/COO) or West Virginia MHT Vice President/Senior Vice President shall serve in a full time (forty [40] hours per week) position available during BMS business hours to fulfill the responsibilities of the position and to oversee the entire operation of the MCO. The CEO/COO or West Virginia MHT Vice President/Senior Vice President shall devote sufficient time to the MCO’s operations to ensure adherence to program requirements and timely responses to BMS. The CEO/COO or West Virginia MHT Vice President/Senior Vice President shall be authorized and empowered to make contractual, operational, and financial decisions for the contract, related to business, claims payment, provider relations/contracting, and all other functions of the MCO. The CEO/COO or West Virginia MHT Vice President/Senior Vice President must be directly employed by the MCO. The CEO/COO or West Virginia MHT Vice President/Senior Vice President must attend in person, upon BMS request, meetings, and hearings of legislative committees, interested governmental bodies, agencies, and officers. The CEO/COO or West Virginia MHT Vice President/Senior Vice President must establish and maintain positive client relationships, make contractual, operational, and financial decisions on behalf of the MCO, and oversee and provider overarching contract oversight for the MCO. The CEO/COO or West Virginia MHT Vice President/Senior Vice President must have at least ten (10) years’ experience in Medicaid managed care oversight and operations, ten (10) years’ experience in healthcare administration and operations, a bachelor’s degree or higher and be based in West Virginia.
2. The Contract Liaison/MHT Administrator is responsible for overall delivery of the project, serving as a liaison with BMS during all phases of the contract. The Administrator must attend in person, upon BMS request, meeting and hearings of legislative committees and interested governmental bodies, agencies, and officers. The Administrator must maintain a positive client relationship, provide timely and informed responses to operational and administrative inquires that arise, meet with BMS staff or such other persons as designated by BMS on a regular basis to provide oral and written status reports and other information as required. The Administrator must respond to issues involving information systems and repor...
Key Staff Requirements. The MCO’s Key Staff must meet the following requirements, as applicable:
1. The Chief Executive Officer/Chief Operating Officer (CEO/COO) is responsible for managing overall operations and resources, provides strategic and operational leadership and direction for the organization. The CEO must directly and with collaboration of subordinates: manage organizational activities; direct public policy, advocacy, and legislative affairs for enrollees; maintain an effective relationship with the Board of Directors; authorize the contract terms and ensure terms are met for the entire contract term; authorize subcontracts as related to the prime vendor contract; and ensure subcontractors meet the terms of the prime contract. The CEO/COO must be actively involved in management of program operations and actively participate in meetings with BMS. The CEO/COO must have at least five (5) years’ experience serving as an executive manager for a managed care entity or other health insurance provider, a Bachelor’s degree or higher and be based in West Virginia.
2. The Contract Liaison/Medicaid Administrator is responsible for overall delivery of the project, serving as a liaison with BMS during all contract phases. The Administrator must attend in person, upon BMS request, meetings and hearings of legislative committees and interested governmental bodies, agencies, and officers. The Administrator must: establish and maintain a positive client relationship; provide timely and informed responses to operational and administrative inquiries; make contractual, operational, and financial decisions, including, but not limited to, claims payment, and provider relations/contracting; and, meet with BMS staff or other person(s) as designated by BMS on a regular basis to provide oral and written status reports and other information as required. The Administrator must respond to issues involving information systems and reporting, appeals, quality improvement, member services, service management, pharmacy management, medical management, care coordination, and issues related to the health, safety, and welfare of the member. The Administrator must ensure each enrollee has an ongoing source of care appropriate to his or her needs and a person or entity formally designated as primarily responsible for coordinating services accessed by the enrollee, per 42 CFR § 438.208(b)(1). The Administrator must have at least five (5) years’ experience in Medicaid managed care contract oversight, substanti...
Key Staff Requirements. SLA Name Key Staff Requirements Performance Standard Positions that are designated as Key Staff shall not remain vacant for more than 30 calendar days. Key Staff positions shall not be filled with employees who shall fulfill the roles and responsibilities of the position in a temporary capacity and/or maintain responsibilities for another position. Effective Date: Agreement Effective Date Measurement Process Positions that are designated as Key Staff shall not remain vacant for more than 30 calendar days. Key Staff positions shall not be filled with employees who shall fulfill the roles and responsibilities of the position in a temporary capacity and/or maintain responsibilities for another position. Failures & Nonexclusive Remedies Liquidated damages for non-compliance shall be assessed at the rate of 0.5% of the applicable monthly invoice for any month in which the contractor fails to achieve the service level set forth in the specification (i.e., the monthly invoice applicable to the 30th day in which the Key Staff position is unfilled). Reporting The Contractor shall report the replacement of Key Staff to the Exchange Project Director.
Key Staff Requirements. Key Staff will be named in the Contract Agreement and are expected to remain available for the full contract term
Key Staff Requirements