Additional Required Staff. In addition to the Key Personnel identified in Exhibit 1, CONTRACTOR shall employ sufficient staff to effectively manage operations. Such staff shall include, but is in no way limited to the staff identified in Exhibit 2. POSITIONS1 POSITION DESCRIPTION FTE2 Number IN-STATE3 South Carolina Specific to Profession IN-STATE3 South Carolina Utilization Review Staff Responsible for Prior Authorization and current reviews. This staff shall include but is not limited to licensed psychologists, clinical social workers, nurses, Physicians and/or physician's assistants. Required 07/01/2018 Member Services Staff Responsible for enabling prompt resolution to member inquiries/problems. 07/01/2018 Provider Services Staff Located in South Carolina and capable of ensuring those Providers receive prompt responses and assistance. Required 07/01/2018 Network Management Claims Processing Staff Ensure the timely and accurate processing of original Claims, resubmissions and overall adjudication of Claims. 07/01/2018 POSITIONS1 POSITION DESCRIPTION FTE2 Number IN-STATE3 South Carolina Specific to Profession IN-STATE3 South Carolina Network Management Encounter Processing Staff Ensure the timely and accurate processing and submission to the Department of Encounter data and reports. 07/01/2018 Quality Assessment and Performance Improvement Staff Sufficient staff qualified by training and experience to be responsible for the operation and success of the Quality Assessment and Performance Improvement Program (QAPI). The QAPI staff shall be accountable for Quality outcomes in all of the CONTRACTOR's own network Providers, as well as Subcontracted Providers, as stated in 42 CFR §§ 438.200 – 438.242 07/01/2018 Case Management Staff Located in South Carolina and provide Care Coordination and for Members with special health care needs. Required 07/01/2018 Compliance/Program Integrity Staff The CONTRACTOR shall have adequate staffing and resources to fulfill the Program integrity and Compliance requirements of this contract, to investigate all reported incidents, and to develop and implement the necessary systems and Procedures for preventing and detecting potential Fraud and Abuse activities. 07/01/2018 REQUIREMENTS EFFECTIVE DATE (MM/DD/YYYY) LOCATION LICENSURE POSITIONS1 POSITION DESCRIPTION FTE2 Number IN-STATE3 South Carolina Specific to Profession IN-STATE3 South Carolina Program Integrity Coordinator The CONTRACTOR must provide for a management official to coordinate Fraud, Waste &...
Additional Required Staff. For the purposes of this requirement, additional required staff are those staff principally responsibility for the functions described below. All additional required staff positions must reside and work in the state of New Mexico, unless prior written approval has been obtained from HCA. Required staff positions may not be filled by staff identified as Key Personnel and additional required staff must reside in the State of New Mexico. The CONTRACTOR shall ensure additional required staff have routine, established access to Key Personnel to improve the Turquoise Care Program and resolve Member issues effectively. Exceptions to the additional required staff requirements (including additional required staff serving in more than one role, depending upon the size of the population being served) must be prior approved in writing by HCA. The CONTRACTOR shall, at a minimum, employ the following additional required staff:
3.3.5.1 The CONTRACTOR shall employ a Justice System Liaison who serves as the CONTRACTOR’s single point of contact for justice system stakeholders (e.g., jails/prisons/detention facilities, probation and parole offices, courts, and law enforcement entities,). The Justice System Liaison shall be responsible for ensuring Care Coordination of Justice-Involved Individuals and collaborates with system stakeholders to engage in collective initiatives (e.g., alternatives to arrest and/or incarceration) to reduce the number of individuals entering the justice system. This position is preferred to have lived experience with the justice system.
3.3.5.2 The CONTRACTOR shall employ a Court Liaison who is the single point of contact for court system stakeholders (e.g., State, federal, county, municipal, and tribal courts) to ensure Member Care Coordination related to court orders and case dispositions. This position is also responsible for coordination of civil commitments and communication of court-related follow-up and requirements to appropriate staff. This allows for increased concentration on oversight and accountability for ensuring providers are adhering to the treatment requirements assigned through court ordered treatment.
3.3.5.3 The CONTRACTOR shall employ a Crisis Administrator who understands the CONTRACTOR’s Behavioral Health crisis services and the Behavioral Health crisis resources and systems across the State. The Crisis Administrator is responsible for collaborating with the other MCOs, other crisis resources in the State, and first responde...
Additional Required Staff. In addition to the Key Personnel identified in Exhibit 1, CONTRACTOR shall employ sufficient staff to effectively manage operations. Such staff shall include but is in no way limited to the staff identified in Exhibit 2.
Additional Required Staff. Prior Authorization staff to authorize health care 24 hours per day, seven days per week. This staff shall include but is not limited to Arizona-licensed nurses, physicians and/or physician's assistant.
Additional Required Staff. At a minimum, the following additional required staff positions must be filled at all times:
1. Care Coordination staff who are located in Arkansas and who provide Care Coordination Services for PASSE Members. The Care Coordination staff must have the minimum qualifications set out in the PASSE Medicaid Provider Manual, Section II. Additionally, the Care Coordination staff must perform all duties described in the Care Coordination Services Requirements and Scope of Care Coordination Services in this Agreement, in addition to any and all duties under applicable law; and
2. IT/IS Staff who are able to ensure timely and accurate information system management to meet system and data exchange requirements as specified in Data and IT Requirements Section of this Agreement.
Additional Required Staff. 2.3.4.1 The Contractor shall have sufficient number of qualified staff with sufficient experience and expertise to meet both physical health services and behavioral health services responsibilities, and shall provide dedicated staff where necessary to meet this obligation including all required timeframes and geographic coverage outlined in this Contract.
2.3.4.2 The Contractor shall comply with additional staffing requirements included in the MCO Manual.
