CARE MANAGEMENT AND COORDINATION Sample Clauses

CARE MANAGEMENT AND COORDINATION. 5.1. General Care Management and Coordination Requirements As part of the Care Management System, the CONTRACTOR shall be responsible for the management, coordination, and Continuity of Care for all its Membership and shall develop and maintain a Programmatic-Level of Policies and Procedures to address this responsibility. The CONTRACTOR shall: 5.1.1. Make a best effort to conduct an initial screen of each Enrollee’s needs, within 90 Days of the effective date of Enrollment for all new Enrollees, including subsequent attempts if the initial attempt to contact the Enrollee is unsuccessful. 5.1.2. Utilize appropriate assessment tools and Health Care Professionals in assessing a members physical and Behavioral Health care needs. 5.1.3. Develop Programmatic-Level Policies and Procedures for Care Management and Coordination of services. 5.1.4. Use Care Management and Coordination as a continuous process for: 5.1.4.1. The assessment of a Member’s physical health, Behavioral Health and social support service and assistance needs, 5.1.4.2. The identification of physical health services, Behavioral Health Services and other social support services and assistance necessary to meet identified needs, and 5.1.4.3. The assurance of timely access to and provision, coordination and monitoring of the identified services associated with physical health, Behavioral Health, and social support service and assistance to help the member maintain or improve his or her health status. 5.2. National Standards Requirements The CONTRACTOR’s Care Management Program and Care Coordination activities shall 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). 5.2.1. Complex Case Management Standards (NCQA) The CONTRACTOR’s shall: 5.2.1.1. Develop a detailed Program description for complex Case Management. 5.2.1.2. Have Policies and Procedures for the assessment of characteristics and needs of its Member population (including children/adolescents, individuals with disabilities and individuals with Serious and Persistent Mental Illness (SPMI), and/or Serious Emotional Disorders (SED)). 5.2.1.3. Have a Case Management System based on sound evidence. 5.2.1.4. Have a systematic process for identifying Members with complex conditions and referring them for Case Management services. 5.2.1.5. Determine the need for enhanced ser...
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CARE MANAGEMENT AND COORDINATION. 5.1. General Care Management and Coordination Requirements As part of the Care 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 shall: 5.1.1. Make a best effort to conduct an initial screen of each Enrollee’s needs, within ninety (90) Days of the effective date of Enrollment for all new Enrollees, including subsequent attempts if the initial attempt to contact the Enrollee is unsuccessful. 5.1.2. Utilize appropriate assessment tools and Health Care Professionals in assessing a members physical and Behavioral Health care needs. 5.1.3. Develop Programmatic-Level Policies and Procedures for Care Management and Coordination of services. 5.1.4. Use Care Management and Coordination as a continuous process for: 5.1.4.1. The assessment of a Member’s physical health, Behavioral Health and social support service and assistance needs, 5.1.4.2. Identification of persons who need LTSS services or persons with special health care needs, 5.1.4.3. The Plan must annually provide, for Department approval, its procedures related to contacting and assessing the needs for LTSS services or other special health care needs 5.1.4.4. The identification of physical health services, Behavioral Health Services, LTSS, special needs and other social support services and assistance necessary to meet identified needs, and 5.1.4.5. The assurance of timely access to and provision, coordination and monitoring of the identified services associated with physical health, Behavioral Health, LTSS, special needs, and social support services and assistance to help the member maintain or improve his or her health status including coordinating access to services not covered by the plan. 5.2. National Standards Requirements The CONTRACTOR’s Care Management Program and Care Coordination activities shall 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). 5.2.1. Complex Case Management Standards (NCQA) The CONTRACTOR shall: 5.2.1.1. Develop a detailed Program description for complex Case Management. 5.2.1.2. Have Policies and Procedures for the assessment of characteristics and needs of its Member population (including children/adolescents, individ...
Sample 1
CARE MANAGEMENT AND COORDINATION. 5.1. General Care Management and Coordination Requirements As part of the Care Management System, the CONTRACTOR shall be responsible for the management, coordination, and continuity of care for all its Membership and shall develop and maintain a programmatic-level of policies and procedures to address this responsibility. The CONTRACTOR shall: 5.1.1. Develop programmatic-level policies and procedures for Care Management and Coordination of services. 5.1.2. Use Care Management and Coordination as a continuous process for: The assessment of a Member’s physical health, behavioral health and social support service and assistance needs, The identification of physical health services, behavioral health services and other social support services and assistance necessary to meet identified needs, and The assurance of timely access to and provision, coordination and monitoring of the identified services associated with physical health, behavioral health, and social support service and assistance to help the member maintain or improve his or her health status. 5.2. National Standards Requirements The CONTRACTOR’s Care Management Program and Care Coordination activities shall 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). 5.2.1. Complex Case Management Standards (NCQA) The CONTRACTOR’s shall: Develop a detailed Program description for Complex Case Management. Have policies and procedures for the assessment of characteristics and needs of its Member population (including children/adolescents, individuals with disabilities and individuals with Serious and Persistent Mental Illness (SPMI), and/or Serious Emotional Disorders (SED)). Have a Case Management System based on sound evidence. Have a systematic process for identifying Members with complex conditions and referring them for case management services. Have automated systems to support the case management staff. Have a Case Management System that ensures appropriate documentation and follow-up. Have a Case Management System with processes for initial assessment and ongoing management of members. Measure its performance and member satisfaction. Have procedures to improve performance when necessary. 5.3. Member Risk Stratification Requirements The CONTRACTOR shall stratify its Members based on risk.
Sample 1
CARE MANAGEMENT AND COORDINATION 
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Related to CARE MANAGEMENT AND COORDINATION

  • Project Management and Coordination The Engineer shall coordinate all subconsultant activity to include quality of and consistency of work and administration of the invoices and monthly progress reports. The Engineer shall coordinate with necessary local entities.

  • Care Management The Contractor’s protocol for referring members to care management shall be reviewed by OMPP and shall be based on identification through the health needs screening or when the claims history suggests need for intervention. In addition to population-based disease management educational materials and reminders, these members should receive more intensive services. Members with newly diagnosed conditions, increasing health services or emergency services utilization, evidence of pharmacy non-compliance for chronic conditions and identification of special health care needs should be strongly considered for case management. Care management services include direct consumer contacts in order to assist members with scheduling, location of specialists and specialty services, transportation needs, 24-Hour Nurse Line, general preventive (e.g. mammography) and disease specific reminders (e.g. Xxx X0X), pharmacy refill reminders, tobacco cessation and education regarding use of primary care and emergency services. The Contractor shall make every effort to contact members in care management telephonically. Materials should also be delivered through postal and electronic direct-to-consumer contacts, as well as web-based education materials inclusive of clinical practice guidelines. Materials shall be developed at the fifth grade reading level. All members with the conditions of interest shall receive materials no less than quarterly. The Contractor shall document the number of persons with conditions of interest, outbound telephone calls, telephone contacts, category of intervention, intervention delivered, mailings and website hits. Care management shall be coordinated with the Right Choices Program for members qualifying for the Right Choices Program. However, the Right Choices Program is not a replacement for care management.

  • Care Coordination The Parties’ subcontract shall require that the Enrollee’s CP Care Coordinator provide ongoing care coordination support to the Enrollee in coordination with the Enrollee’s PCP and other providers as set forth in Section 2.6.

  • Cooperation and Coordination The Parties acknowledge and agree that it is their mutual objective and intent to minimize, to the extent feasible and legal, taxes payable with respect to their collaborative efforts under this Agreement and that they shall use all commercially reasonable efforts to cooperate and coordinate with each other to achieve such objective.

  • Project Coordination The Engineer shall coordinate all subconsultant activity to include quality and consistency of deliverables and administration of the invoices and monthly progress reports. The Engineer shall coordinate with necessary local entities.

  • Project Management Plan 3.2.1 Developer is responsible for all quality assurance and quality control activities necessary to manage the Work, including the Utility Adjustment Work. Developer shall undertake all aspects of quality assurance and quality control for the Project and Work in accordance with the approved Project Management Plan, Good Industry Practice and applicable Law. 3.2.2 Developer shall develop the Project Management Plan and its component parts, plans and other documentation in accordance with the requirements set forth in Section 1.5.2.5

  • Coordination The Parties shall confer regularly to coordinate the planning, scheduling and performance of preventive and corrective maintenance on the Large Generating Facility and the Interconnection Facilities.

  • Construction Management Services a. A-E may be required to review and recommend approval of submittals, shop drawings, Request for Information (RFI) and/or calculations for temporary structures such as trench shoring, false work and other temporary structural forms. b. A-E may be required to review and advise the County Representative on the overall project schedule, including staging and completion dates, duration, milestones, and interfaces. Immediately notify Representative if the proposed work schedule does not conform to the contract documents, including the plans, specifications, and permits or that may require special inspection or testing, or work stoppage. c. Review on a monthly basis the project schedule and/or Critical Path Method (CPM) schedule submitted by the Construction Contractor. Make recommendations concerning the Construction Contractor’s adherence thereto. Recommend possible solutions to scheduling problems so as to complete the project on time, within budget, and in accordance with the contract drawings and specifications. d. Review scope of work and identify potential contract change orders. Prepare independent cost estimates for any changes resulting from design revisions or change in field conditions. Prepare and recommend for approval all contract change orders. e. Evaluate the merit of any potential claims or requests for equitable adjustment submitted by the Construction Contractor. Prepare analysis of potential claims include recommendations regarding settlement of the claims. f. Assist County staff in project related issues with other Agencies, or departments, engineering and material testing support firms, CEQA consultants, utilities agencies, etc. g. Assist in community outreach meetings and media relations h. Review for acceptance/approval of Storm Water Pollution Prevention Plan (SWPPP) in accordance with the general Permit of Discharges of Storm Water Associated with Construction Activity (Construction General Permit, including dewatering/diversion plans per the State’s DeMinimus Permit).

  • Project Management Project Management Institute (PMI) certified project manager executing any or all of the following: • Development of Project Charter • Development of project plan and schedule • Coordination and scheduling of project activities across customer and functional areas • Consultation on operational and infrastructure requirements, standards and configurations • Facilitate project status meetings • Timely project status reporting • Address project issues with functional areas and management • Escalation of significant issues to customers and executive management • Manage project scope and deliverable requirements • Document changes to project scope and schedule • Facilitate and document project closeout

  • Information Management Information and Records

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