Care Coordination and Case Management. 4.11.7.1 The Contractor shall be responsible for the Care Coordination/Case Management of all Members and shall make special effort to identify Members who have the greatest need for Care Coordination, including those who have catastrophic, or other high-cost or high-risk Conditions.
Care Coordination and Case Management. 5.1 General Care Coordination and Case Management Requirements As part of the Care Coordination and Case Management System, the CONTRACTOR shall be responsible for the management, coordination, and Continuity of Care for all its Membership and shall develop and maintain Policies and Procedures to address this responsibility. The CONTRACTOR’s Care Coordination activities and Case Management Program shall be based on sound evidence and conform to the requirements and industry standards stipulated in the NCQA requirements for Complex Case Management and by the Standards of Practice of Case Management released by the Case Management Society of America (CMSA). The CONTRACTOR shall:
