Other Required Staff Positions. In addition to the key staff positions outlined in Section 2.10.2, the Contractor is required to employ the following staff: Part-time or on-call board certified psychiatrist and addictionologist for behavioral health utilization management activities; A sufficient number of care management staff based within Indiana to meet the requirements outlined in Section 5.0. Care managers for complex case management and RCP described in further detail in Sections 5.2.3, 5.2.4 and 5.2.5, must be licensed physician assistants, registered nurses, therapists, or social workers and have training, expertise and experience in providing case management and care coordination services for individuals, including specialized populations such as wards and xxxxxx children, with the conditions prevalent in the Hoosier Care Connect population; and
Other Required Staff Positions. In addition to the required key staff described in Section 2.3.2, the Contractor shall employ those additional staff necessary to ensure the Contractor’s compliance with the State’s performance requirements. Required staff includes but are not limited to: Xxxxxxxxx and appeals staff necessary to investigate and coordinate responses to address member and provider grievances and appeals against the Contractor and interface with the FSSA and the Indiana Office of Administrative Law Proceedings. Technical support services staff to ensure the timely and efficient maintenance of information technology support services, production of reports, processing of data requests and submission of encounter data. Quality improvement staff dedicated to perform quality management and improvement activities, and participate in the Contractor’s internal Quality Assessment and Performance Improvement Committee. Utilization and medical management staff dedicated to perform utilization management and review activities. Case managers who provide case management, care management, care coordination and utilization management for high-risk or high-cost members receiving physical health and/or behavioral health services. The case managers must identify the needs and risks of the Contractor’s membership, including social barriers; serve as a coordinator to link members to services; and ensure that members receive the appropriate care in the appropriate setting by the appropriate providers. Board certified psychiatrist and addiction specialist part-time or on-call board certified psychiatrist and addiction specialist with qualifications and certification as outlined by ASAM for behavioral health utilization management activities. Member services representatives to coordinate communications between the Contractor and its members; respond to member inquiries; and assist all members regarding issues such as the Contractor’s policies, procedures, general operations, benefit coverage and eligibility. Member services staff should have access to real time data for members, including eligibility status, benefit package, balance and transactions, PMP assignments and all service and utilization data. Member services staff shall have the appropriate training and demonstrate full competency before interacting with members. Member marketing and outreach staff to manage marketing and outreach efforts for the Hoosier Healthwise program. Special Investigation Unit staff to support the Special Investiga...
Other Required Staff Positions. In addition to the key staff positions outlined in Section 2.10.2, the Contractor is required to employ the following staff:
Other Required Staff Positions. In addition to the key staff positions outlined in Section 2.10.2, the Contractor is required to employ the following staff: ▪ Part-time or on-call board certified psychiatrist and addiction specialist with qualifications and certification as outlined by ASAM for behavioral health utilization management activities; ▪ A sufficient number of care management staff based within Indiana to meet the requirements outlined in Section 5.0. Care managers for complex case management and RCP described in further detail in Sections 5.2.3, 5.2.4 and 5.2.5, must be licensed physician assistants, registered nurses, therapists, or social workers and have training, expertise and experience in providing case management and care coordination services for individuals, including specialized populations EXHIBIT 1.C SCOPE OF WORK such as wards and xxxxxx children, with the conditions prevalent in the Hoosier Care Connect population; and
Other Required Staff Positions. In addition to the required key staff described in Section 2.4.2, the Contractor shall employ those additional staff necessary to ensure the Contractor’s compliance with the State’s performance requirements. Required staff includes but are not limited to: Xxxxxxxxx and Appeals Staff necessary to investigate and coordinate responses to address member and provider grievances and appeals against the EXHIBIT 1 SCOPE OF WORK – INDIANA PATHWAYS FOR AGING Contractor and interface with the FSSA and the Indiana Office of Administrative Law Proceedings. Technical Support Services staff to ensure the timely and efficient maintenance of information technology support services, production of reports, processing of data requests, and submission of encounter data. Quality Improvement Staff dedicated to performing quality management and improvement activities, participating in the Contractor’s internal Quality Assessment and Performance Improvement Committee. The Contractor shall include at least one (1) designated professional with expertise in the assessment and delivery of LTSS who will be substantially involved in the quality program. Utilization and Medical Management Staff of which a minimum of seventy (70) percent are located in Indiana. The utilization and medical management staff are dedicated to performing utilization management and review activities. These individuals who review authorizations for the PathWays program must have experience in long term services and supports or the care of older adults. Case Management Supervisor(s) who is an Indiana licensed registered nurse or an Indiana licensed Master’s level social worker/therapist with a minimum of three years of case management experience. The Case Management Supervisor(s) must be located in Indiana to oversee case management staff. This individual must have experience in long term services and supports or the care of older adults. Care Coordinators shall be located in Indiana and licensed as applicable in Indiana. Care Coordinators for complex case management and RCP must be (1) an Indiana licensed registered nurse (2) an Indiana licensed Master’s degree in social work or therapist, and have training, expertise, and experience in providing case management and care coordination services for individuals, including specialized populations such as older adults and/or individuals with physical or developmental disabilities and/or individuals determined to have a serious mental illness (SMI). Service Coordinato...
Other Required Staff Positions. In addition to the key staff positions outlined in Section 2.10.2, the Contractor is required to employ the following staff: • Part-time or on-call board certified psychiatrist and addiction specialist with qualifications and certification as outlined by ASAM for behavioral health utilization management activities; • A sufficient number of care management staff based within Indiana to meet the requirements outlined in Section 5.0. Care managers for complex case management and RCP described in further detail in Sections 5.2.3, 5.2.4 and 5.2.5, must be licensed physician assistants, registered nurses, therapists, or social workers and have training, expertise and experience in providing case management and care coordination services for individuals, including specialized populations such as wards and xxxxxx children, with the conditions prevalent in the Hoosier Care Connect population; and • A Transition Coordinator responsible for oversight of the continuity of care requirements outlined in Section 3.15. This individual shall be dedicated to oversight of all member transitions in and out of the Hoosier Care Connect program and the Contractor’s enrollment. The Transition Coordinator shall be responsible for ensuring the transfer and receipt of all outstanding prior authorization decisions, utilization management data and clinical information such as disease management, care management and complex case management notes. • Special Investigation Unit staff to support the Special Investigation Unit Manager and help review and investigate Contractor’s providers and members that are engaging in wasteful, abusive, or fraudulent billing or service utilization. The SIU shall have, at a minimum, one full-time, dedicated staff member for every 100,000 members, excluding the SIU Manager. Accordingly, for example, plans servicing 360,000 members shall have a Special Investigation Unit Manager and 3.6 FTE additional staff. A majority of SIU staff including the SIU Manager shall work in Indiana to enable sufficient onsite audit capability and facilitate in-person meeting attendance as directed by FSSA.
