Quality Management and Utilization Review Committee. 1. The Member Advisory Committee shall establish, maintain, and provide support to a Quality Management and Utilization Review Committee, and be accountable to the Governing Body on issues addressed by the Quality Management and Utilization Review Committee.
2. The Quality Management and Utilization Review Committee shall provide guidance and assistance to support the Contractor in carrying out the following quality management responsibilities:
a. Developing mechanisms for collecting and evaluating information, identifying problems, formulating recommendations, disseminating information, implementing corrective actions, and evaluating the effectiveness of actions taken;
b. Reviewing annually and making recommendations concerning the formulation, revision or implementation of the policies governing the scope of services offered, practice guidelines, medical supervision, ISPs, crisis intervention care, clinical records, personnel qualifications and program evaluation;
c. Providing technical advice regarding professional questions and individual service problems;
d. Participating in program evaluation including annual evaluation of the Contractor's performance;
e. Assisting in maintaining liaison with professional groups and health providers in the community;
f. Participating in the development and ongoing review of written policies, procedures, and standards of patient care and quality management;
g. Reviewing the adequacy and effectiveness of quality management and utilization activities on a quarterly basis; and
h. Developing mechanisms for evaluating responsiveness of the Complaint and Grievance processes and for collecting and analyzing information about voluntary disenrollments.
Quality Management and Utilization Review Committee. 1. The Member Advisory Committee shall establish, maintain, and provide support to a Quality Management and Utilization Review Committee, and be accountable to the Governing Body on issues addressed by the Committee.
2. The Quality Management and Utilization Review Committee shall provide guidance and assistance to support the Contractor in carrying out the following quality management responsibilities:
a. Developing mechanisms for collecting and evaluating information, identifying problems, formulating recommendations, disseminating information, implementing corrective actions, and evaluating the effectiveness of action taken;
b. Reviewing annually and making recommendations concerning the formulation, revision or implementation of the policies governing the scope of services offered, practice guidelines, medical supervision, ISPs, crisis intervention care, clinical records, personnel qualifications and program evaluation;
c. Providing technical advice regarding professional questions and individual service problems;
d. Participating in program evaluation including annual evaluation of the Contractor's performance;
e. Assisting in maintaining liaison with professional groups and health providers in the community;
f. Participating in the development and ongoing review of written policies, procedures, and standards of patient care and quality management;
g. Reviewing the adequacy and effectiveness of quality management and utilization activities on a quarterly basis; and
h. Developing mechanisms for evaluating responsiveness of the Complaint and Grievance processes and for collecting and analyzing information about voluntary disenrollments.
Quality Management and Utilization Review Committee. 1. The Member Advisory Committee shall establish, maintain, and provide support to a Quality Management and Utilization Review Committee, and be accountable to the Governing Body on issues addressed by the Committee.
2. The Quality Management and Utilization Review Committee shall provide guidance and assistance to support the Contractor in carrying out the following quality management responsibilities:
a. Developing mechanisms for collecting and evaluating information, identifying problems, formulating recommendations, disseminating information, implementing corrective actions, and evaluating the effectiveness of action taken;
b. Reviewing annually and making recommendations concerning the formulation, revision or implementation of the policies governing the scope of services offered, practice guidelines, medical supervision, ISPs, crisis intervention care, clinical records, personnel qualifications and program evaluation;
c. Providing technical advice regarding professional questions and individual service problems;
d. Participating in program evaluation including annual evaluation of the Contractor's performance;
e. Assisting in maintaining liaison with professional groups and health providers in the community;
f. Participating in the development and ongoing review of written policies, procedures, and standards of patient care and quality management;
