Common use of Special Investigation Unit Manager Clause in Contracts

Special Investigation Unit Manager. The Contractor shall employ a Special Investigation Unit (SIU) Manager who is dedicated full-time to the Contractor’s Indiana Medicaid product lines. The SIU Manager shall be located in Indiana. The SIU Manager is responsible for directing the activities of Special Investigation Unit staff, attending meetings with FSSA and reducing or eliminating wasteful, fraudulent, or abusive healthcare xxxxxxxx and services. It is the responsibility of the SIU Manager to coordinate the timeliness, accuracy and completeness of all suspected or confirmed instances of waste, fraud and abuse referrals to the OMPP PI Unit. The SIU Manager shall report to the Compliance Officer and meet with the OMPP Program Integrity (OMPP PI) Unit at a minimum of quarterly or more frequently as directed by the OMPP PI Unit. The Special Investigation Unit Manager shall be a subject matter expert in Medicaid program integrity and hold qualifications similar to those of state program integrity unit managers. The SIU Manager shall be required to interview with the OMPP PI Unit prior to obtaining FSSA approval Quality Improvement Management Manager – The Contractor shall employ a Quality Management Manager who is dedicated full-time to the Contractor’s Indiana Medicaid product lines. The Quality Improvement Management Manager shall, at a minimum, be responsible for directing the activities of the Contractor’s quality management staff in monitoring and auditing the Contractor’s health care delivery system, including, but not limited to, internal processes and procedures, provider network(s), service quality and clinical quality. The Quality Improvement Management Manager shall assist the Contractor’s Compliance Officer in overseeing the activities of the Contractor’s operations to meet the State’s goal of providing health care services that improve the health status and health outcomes of HIP members. For more information regarding the quality management requirements, see Section 9.

Special Investigation Unit Manager. The Contractor shall employ a Special Investigation Unit (SIU) Manager who is dedicated full-time to the Contractor’s Indiana full- Medicaid product lines. The SIU Manager shall be located in Indiana. The SIU Manager is responsible for directing the activities of Special Investigation Unit staff, attending meetings with FSSA and reducing or eliminating wasteful, fraudulent, or abusive healthcare xxxxxxxx and services. It is the responsibility of the SIU Manager to coordinate the timeliness, accuracy and completeness of all suspected or confirmed instances of waste, fraud and abuse referrals to the OMPP PI Unit. The SIU Manager shall report to the Compliance Officer and meet with the OMPP Program Integrity (OMPP PI) Unit at a minimum of quarterly or more frequently as directed by the OMPP PI Unit. The Special Investigation Unit Manager shall be a subject matter expert in Medicaid program integrity and hold qualifications similar to those of state program integrity unit managers. The SIU Manager shall be required to interview with the OMPP PI Unit prior to obtaining FSSA approval approval. Quality Improvement Management Manager – The Contractor shall employ a Quality Improvement Management Manager who is dedicated full-time to the Contractor’s full- Indiana Medicaid product lines. The Quality Improvement Management Manager shall, at a minimum, be responsible for directing the activities of the Contractor’s quality management staff in monitoring and auditing the Contractor’s health care delivery system, including, but not limited to, internal processes and procedures, provider network(s), service quality and clinical quality. The Quality Improvement Management Manager shall assist the Contractor’s Compliance Officer in overseeing the activities of the Contractor’s operations to meet the State’s goal of providing health care services that th improve the health status and health outcomes of HIP Hoosier Healthwise members. For more information regarding the quality management requirements, see Section 96.