Common use of Quality Management Committee Clause in Contracts

Quality Management Committee. The Contractor must operate under a formal organizational structure for the implementation and oversight of the internal quality management program. The formal organizational structure must include at a minimum, the following: a. Established parameters of operation including specifics regarding role, function and structure; b. A designated health care practitioner, qualified by training and experience, to serve as the QM director; c. A committee Enrolleeship which includes representatives from the provider groups as well as clinical and non-clinical areas of the organization; d. A senior executive who is responsible for program implementation; e. Substantial involvement in QM activities by the Contractor's Medical Director; f. QM activities must be distinctly separate from the Utilization Review activities and that distinction must be well defined; g. The QM committee must meet on a regular basis with specified frequency to oversee QM activities. This frequency will be sufficient to demonstrate that the committee is following up on all findings and required actions, but in no case are such meetings to be less frequent than quarterly; h. Records that document the committee's activities, findings, recommendations, actions, and results; and i. Accountability to the governing body of the organization to which it reports on activities, findings, recommendations, actions, and results on a scheduled basis.