Medical Director/Chief Medical Officer. The Medical Director/Chief Medical Officer (CMO) must be a physician with a current, unencumbered license through the Ohio State Medical Board. The Medical Director must have at least three years of training in a medical specialty. The responsibilities of the Medical Director/CMO include but are not limited to: Ensuring that the MCO makes timely medical decisions, including after-hours consultation as needed; Leading all major clinical, population health management, and quality improvement components of the MCO; Developing, implementing, and interpreting medical policies and procedures, including service authorization, claims review, discharge planning, and medical reviews performed through the MCO's grievance and appeal system; Leading the administration of all medical management activities of the MCO; and Serving as the director of the Utilization Management (UM) committee and chairperson or co-chair of the Quality Assessment and Performance Improvement (QAPI) committee.
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
