Utilization Management Committee Sample Clauses

Utilization Management Committee. The Contractor shall establish an internal UM Committee, including Kentucky-based provider representation, that focuses on oversight of clinical service delivery trends across its membership, including evaluating utilization, patterns of care, and key utilization indicators. The Contractor’s Medical Director shall chair or co-chair the UM Committee report findings to the Quality Improvement Committee. The UM Committee shall review, at a minimum:
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Utilization Management Committee. The committee shall have written parameters for operating and will meet on a regular schedule, defined to be at least quarterly. Committee members shall be clearly identified and representative of the contractor's providers, accountable to the medical director and governing body, and shall maintain appropriate documentation of the committee's activities, findings, recommendations, and actions.
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Utilization Management Committee. The MCO must have a utilization management committee directed by the MCO’s Medical Director. The committee is responsible for: • Monitoring the MCO’s provider’s requests for rendering medically appropriate and necessary health care services to its members • Reviewing the effectiveness of the utilization review process and making changes to the process as needed HOOSIER HEALTHWISE STATE/MCO CONTRACT CONTRACT ATTACHMENT 1: MCO SCOPE OF WORK • Writing policies and procedures for utilization management that conform to industry standards including methods, timelines and individuals responsible for completing each task • Confirming the MCO has an effective mechanism in place to respond within one hour to all emergency room providers 24-hours-a-day, seven-days-a-week: • After the MCO’s member’s initial emergency room screening, and • After the MCO’s member has been stabilized and the emergency room provider believes continued treatment is necessary to maintain stabilization. OMPP may waive certain administrative requirements, including prior authorization procedures, to the extent that such waivers are allowed by law and are consistent with policy objectives. The MCO may be required to comply with such waivers and will be provided with prior notice by OMPP.
Sample 1
Utilization Management Committee. (Operations Committee) Reports to the ACO’s Board of Managers Objectives  Review of financial and utilization data practices of the network physicians; makes recommendations to the ACO Board regarding improvement opportunities and practices. 1. Xxxxxxxxx Xxxxxx, M.D., DuPage Medical Group, Ltd. 2. Xxx Xxxxxx, M.D., Elmhurst Memorial Healthcare 3. Xxxxx Xxxxx, M.D., DuPage Medical Group, Ltd. 4. Xxxxx-Xx Xxxx, M.D., Xxxxxx Medical Group 5. Xxxxx Xxxxx, M.D., Independent Physician Practice Participant 6. Xxxxxx Xxxx, M.D., DuPage Medical Group, Ltd. 7. Xxxxxx Xxxxxxx, M.D., Elmhurst Memorial Healthcare 8. Xxxxxxx Xxxxxxxxxx, M.D., Medical Director, Illinois Health Partners ACO, DuPage Medical Group, Ltd. 9. Xxxxx Xxxxxxxxx, M.D., Xxxxxx Medical Group 10. Xxxxxxx Xxxxx, M.D., Elmhurst Memorial Healthcare 11. Xxxxxxxx Xxxxxxx, M.D., DuPage Medical Group, Ltd. 12. Xxxxx Xxxxx, M.D., Linden Oaks Hospital 13. Xxxx Xxxx, M.D., DuPage Medical Group, Ltd. 14. Xxxxx Xxxxxx, M.D., Xxxxxx Health Ventures 15. Xxx Xxxxxxx, M.D., Xxxxxx Medical Group 16. Xxxxx Xxxxx, M.D., Independent Physician Practice Participant 17. Xxxxx Xxxxxx, M.D., Elmhurst Memorial Hospital Name of Committee/Duties Members
Sample 1
Utilization Management Committee. Medical Group shall establish and maintain a Utilization Management Committee consisting of at least three (3) Medical Group Physicians. The Utilization Management committee shall meet as frequently as necessary but at least bi-weekly and shall keep minutes of the committee meetings, copies of which shall be made available for review by PacifiCare from time to time upon request. The confidentiality of all such minutes shall be protected to the fullest extent consistent with applicable law. Medical Group agrees that, when appropriate and upon reasonable notice, PacifiCare's Medical Director or a member of the PacifiCare medical services staff may participate in Medical Group Utilization Management Committee meetings during the discussion of matters relating to medical care provided to PacifiCare Members.
Sample 1
Utilization Management Committee. The Federation shall designate one RNCM and one alternate RNCM to be a delegate during the administrative portion of the Utilization Management Committee. The purpose of the RNCM delegate shall be to provide additional insight and expertise on relevant Utilization Management issues and to assist the Department Manager in communicating with others.”
Sample 1
Utilization Management Committee. The Contractor must have a utilization management committee directed by the Contractor’s Medical Director. The committee shall be responsible for:  Monitoring providers’ requests for rendering health care services to its members;  Monitoring the medical appropriateness and necessity of health care services provided to its members;  Reviewing the effectiveness of the utilization review process and making changes to the process as needed;  Writing policies and procedures for utilization management that conform to industry standards including methods, timelines and individuals responsible for completing each task; and  Confirming the Contractor has an effective mechanism in place for a plan provider or Contractor representative to respond within one hour to all emergency room providers twenty four (24)-hours-a-day, seven (7)-days-a-week:  After the Contractor’s member’s initial emergency room screening; and,  After the Contractor’s member has been stabilized and the emergency room provider believes continued treatment is necessary to maintain stabilization.
Sample 1
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Utilization Management Committee. The Contractor shall have a utilization management committee directed by the Contractor’s Medical Director. The same committee may be responsible for all State Medicaid lines of business. The committee shall be responsible for:  Monitoring providers’ requests for rendering health care services to its members;  Monitoring the medical appropriateness and necessity of health care services provided to its members;  Reviewing the effectiveness of the utilization review process and making changes to the process as needed;  Writing policies and procedures for utilization management that conform to industry standards including methods, timelines and individuals responsible for completing each task; and  Confirming the Contractor has an effective mechanism in place for a plan provider or Contractor representative to respond within one hour to all emergency room providers twenty four (24)-hours-a-day, seven (7)-days-a-week:  After the Contractor’s member’s initial emergency room screening; and,  After the Contractor’s member has been stabilized and the emergency room provider believes continued treatment is necessary to maintain stabilization.
Sample 1

Related to Utilization Management Committee

  • Union-Management Committee There shall be a union/management committee comprised of four (4) employee representatives appointed by the Union and four (4) employer representatives. The Committee's purpose is to provide and promote effective and meaningful communication of information and ideas and to make joint recommendations on matters of concern. Matters that are properly the subject of an individual grievance will not be discussed at this committee. The Committee will meet quarterly, unless agreed otherwise, at a time and place mutually agreed to provided there is business for their joint consideration. The parties will exchange agenda items at least one (1) week prior to the meeting. The parties further agree the Committee may meet at any time its members mutually agree a meeting should be held. The duties of the Chairperson will be shared by the parties. Copies of the minutes shall be provided to Committee members. The employer agrees to pay for time spent during regular working hours for representatives of the union attending such meetings. The parties may utilize video or teleconferencing services for the purposes of committee members attending committee meetings, where appropriate and available. Neither party can unreasonably deny an initiative to utilize video or teleconferencing services.

  • Joint Union/Management Committee It shall be appropriate for either the Union or the University to request that a Joint Union/Management committee be convened, with Environmental Health and Safety as a participating member, to discuss health and safety concerns and to explore options for addressing those concerns through appropriate training or other approaches.

  • Labour Management Committee (a) Where the parties mutually agree that there are matters of mutual concern and interest that would be beneficial if discussed at a Labour-Management Committee Meeting during the term of this Agreement, the following shall apply.

  • Utilization Management Contractor shall maintain a utilization management program that complies with applicable laws, rules and regulations, including Health and Safety Code § 1367.01 and other requirements established by the applicable State Regulators responsible for oversight of Contractor.

  • JOINT LABOUR MANAGEMENT COMMITTEE 18.01 A Joint Labour Management Committee shall be established to attend to those matters which are of mutual interest. To ensure its effectiveness the Committee shall be separate and apart from the grievance procedure.

  • Management Committee The Members shall act collectively through meetings as a "committee of the whole," which is hereby named the "Management Committee." The Management Committee shall conduct its affairs in accordance with the following provisions and the other provisions of this Agreement:

  • LABOR MANAGEMENT COMMITTEE 1. A Statewide Labor Management Committee consisting of not more than five (5) members selected by the VSEA from among bargaining units represented by VSEA and not more than five (5) members selected by the State shall meet periodically to discuss a mutually agreed agenda which may include methods of improving labor relations, productivity, safety, and health problems of a continuing nature, or other problems which have an impact on conditions of employment; provided, however, these sessions are not for the purpose of discussing pending grievances or for collective bargaining on any subject.

  • Development Committee As soon as practicable, the Parties will establish a joint development committee, comprised of up to [**] representatives of Verve and up to [**] representatives of Acuitas (the “JDC”). One such representative from each Party will be such Party’s Workplan Leader. Each Party may replace its Workplan Leader and other JDC representatives at any time upon written notice to the other Party, provided, however, that each Party shall use reasonable efforts to ensure continuity on the JDC. With the consent of the other Party (which will not be unreasonably withheld, conditioned or delayed), each Party may invite non-voting employees and consultants to attend JDC meetings, subject to their agreement to be bound to the same extent as a permitted subcontractor under Section 3.1(i).

  • LABOR/MANAGEMENT COMMITTEES Section 1. Labor/Management Committees The parties recognize that the holding of periodic meetings for the exchange of views and information contributes to the effectiveness of the labor/management relationship. Therefore, the parties shall establish Labor/Management Committees (LMC), in accordance with the provisions in this Article, for the purpose of addressing matters of concern in the areas of personnel policies, practices, conditions of employment, and other matters affecting employees. Each LMC will be co-chaired by one member from labor and one member from management.

  • Joint Consultative Committee 45.1 The parties recognise the need for effective communication to improve the business/operational performance and working environment in agencies.

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