Clinical Care Manager. A licensed registered nurse or other individual licensed and/or certified to provide Clinical Care Management, and will serve as the Care Coordinator for individuals with Complex Care Needs.
Clinical Care Manager a licensed Registered Nurse or other individual, employed by the Contractor or an Enrollee’s PCP and licensed to provide clinical care management, including intensive monitoring, follow-up, and care coordination, clinical management of high-risk Enrollees, as further specified by EOHHS. Clinical Criteria – criteria used to determine the most clinically appropriate and necessary level of care and intensity of services to ensure the provision of Medically Necessary services.
Clinical Care Manager a licensed Registered Nurse or other individual, employed by the Contractor or an Attributed Member’s PCP and licensed to provide clinical care management, including intensive monitoring, follow-up, and care coordination, and clinical management of high-risk Attributed Members, as further specified by EOHHS. Clinical Quality Measures – clinical information from Attributed Members’ medical records used to determine the overall quality of care received by Attributed Members or Members. Clinical Quality Measures are a subset of Quality Measures and are set forth in Appendix B. Cold-call Marketing – any unsolicited personal contact by the Contractor, its employees, providers, agents or Material Subcontractors with a Member who is not attributed to the Contractor’s plan that EOHHS can reasonably interpret as influencing the Member to enroll in or either not to enroll in, or to disenroll from, another MassHealth-contracted ACO, MassHealth-contracted Managed Care Organization, or the PCC Plan. Cold-call Marketing shall not include any personal contact between a provider and a Member who is a prospective, current or former patient of that provider regarding the provisions, terms or requirements of MassHealth as they relate to the treatment needs of that particular member. Community Partners (CPs) – entities procured by EOHHS to work with ACOs and MCOs to ensure integration of care, as further specified by EOHHS. Includes BH CPs and LTSS CPs.
Clinical Care Manager a licensed Registered Nurse or other individual, employed by the Contractor or an Enrollee’s PCC and licensed to provide clinical care management, including intensive monitoring, follow-up, and care coordination, and clinical management of high-risk Enrollees, as further specified by EOHHS. Clinical Quality Measures – clinical information from Enrollees’ medical records used to determine the overall quality of care received by Enrollees or Members. Clinical Quality Measures are a subset of Quality Measures and are set forth in Appendix B. Cold-call Marketing – any unsolicited personal contact by the Contractor, its employees, Providers, agents or Material Subcontractors with a Member who is not enrolled in the Contractor’s plan that EOHHS can reasonably interpret as influencing the Member to enroll in the Contractor’s plan or either not to enroll in, or to disenroll from, another MassHealth-contracted Accountable Care Organization, MassHealth-contracted MCO, or the PCC Plan. Cold-call Marketing shall not include any personal contact between a Provider and a Member who is a prospective, current or former patient of that Provider regarding the provisions, terms or requirements of MassHealth as they relate to the treatment needs of that particular member. Community Partners (CPs) – entities certified by EOHHS to work with ACOs and MCOs to ensure integration of care, as further specified by EOHHS. Includes BH CPs and LTSS CPs.
Clinical Care Manager a licensed Registered Nurse or other individual, employed by the Contractor or an Enrollee’s PCP and licensed to provide clinical care management, including intensive monitoring, follow-up, and care coordination, clinical management of high-risk Enrollees, as further specified by EOHHS. Clinical Criteria – criteria used to determine the most clinically appropriate and necessary level of care and intensity of services to ensure the provision of Medically Necessary services. Clinical Quality Measures – clinical information from Enrollees’ medical records used to determine the overall quality of care received by Enrollees or Members. Clinical Quality Measures are a subset of Quality Measures and are set forth in Appendix Q. Cold-call Marketing – any unsolicited personal contact by the Contractor, its employees, Providers, agents or Material Subcontractors with a Member who is not enrolled in the Contractor’s Plan that EOHHS can reasonably interpret as influencing the Member to enroll in the Contractor’s Plan or either not to enroll in, or to disenroll from, another MassHealth-contracted ACO, a MassHealth-contracted Managed Care Organization (MCO) or the PCC Plan. Cold-call Marketing shall not include any personal contact between a Provider and a Member who is a prospective, current or former patient of that Provider regarding the provisions, terms or requirements of MassHealth as they relate to the treatment needs of that particular member.
