Grievance and Appeal Director. The primary functions of the Grievance and Appeal Director are to: Establish and implement a grievance and appeals system pursuant to OAC rule 5160-26-08.4 and in accordance with 42 CFR Part 438, Subpart F; Ensure the MCO's grievance and appeals system functions in two ways: As an essential process to remediate member access to care and quality concerns; and As a source of information that serves as indicators of health care system issues and concerns. Share and review grievance and appeal system data with other operational areas, such as population health/quality management, utilization management, network management, member services, and program integrity to collectively develop and monitor interventions to correct system deficiencies.
Appears in 4 contracts
Samples: Ohio Medicaid Provider Agreement for Managed Care Organization, Ohio Medicaid Provider Agreement for Managed Care Organization, Ohio Medicaid Provider Agreement for Managed Care Organization
Grievance and Appeal Director. 1. The primary functions of the Grievance and Appeal Director are to: Establish and implement a grievance and appeals system pursuant to OAC rule 5160-26-08.4 and in accordance with 42 CFR Part 438, Subpart F; Ensure the MCO's grievance and appeals system functions in two ways: As an essential process to remediate member access to care and quality concerns; and As a source of information that serves as indicators of health heath care system issues and concerns. Share and review grievance and appeal system data with other operational areas, such as population health/quality management, utilization management, network management, member services, and program integrity to collectively develop and monitor interventions to correct system deficiencies.
Appears in 1 contract
Samples: Ohio Medicaid Provider Agreement
