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:
A. The need for and approval of any changes in UM policies, standards, and procedures, including approval and implementation of clinical guidelines, and approving and monitoring the UM program description and work plan.
▇. ▇▇▇▇▇▇▇▇▇▇ and Appeals (including expedited Appeals and State Fair Hearings) related to UM activities to determine any needed policy changes.
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.
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 has been stabilized and the emergency room provider believes continued treatment is necessary to maintain stabilization.
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. ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, M.D., DuPage Medical Group, Ltd. 2. ▇▇▇ ▇▇▇▇▇▇, M.D., Elmhurst Memorial Healthcare 3. ▇▇▇▇▇ ▇▇▇▇▇, M.D., DuPage Medical Group, Ltd. 4. ▇▇▇▇▇-▇▇ ▇▇▇▇, M.D., ▇▇▇▇▇▇ Medical Group 5. ▇▇▇▇▇ ▇▇▇▇▇, M.D., Independent Physician Practice Participant 6. ▇▇▇▇▇▇ ▇▇▇▇, M.D., DuPage Medical Group, Ltd. 7. ▇▇▇▇▇▇ ▇▇▇▇▇▇▇, M.D., Elmhurst Memorial Healthcare 8. ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇, M.D., Medical Director, Illinois Health Partners ACO, DuPage Medical Group, Ltd. 9. ▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇, M.D., ▇▇▇▇▇▇ Medical Group 10. ▇▇▇▇▇▇▇ ▇▇▇▇▇, M.D., Elmhurst Memorial Healthcare 11. ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇, M.D., DuPage Medical Group, Ltd. 12. ▇▇▇▇▇ ▇▇▇▇▇, M.D., Linden Oaks Hospital 13. ▇▇▇▇ ▇▇▇▇, M.D., DuPage Medical Group, Ltd. 14. ▇▇▇▇▇ ▇▇▇▇▇▇, M.D., ▇▇▇▇▇▇ Health Ventures 15. ▇▇▇ ▇▇▇▇▇▇▇, M.D., ▇▇▇▇▇▇ Medical Group 16. ▇▇▇▇▇ ▇▇▇▇▇, M.D., Independent Physician Practice Participant 17. ▇▇▇▇▇ ▇▇▇▇▇▇, M.D., Elmhurst Memorial Hospital
Utilization Management Committee. UMC). A committee operating within HFC whose function is to ensure both quality and cost-effectiveness of treatment.
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.
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 • 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.
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.”