Specific Required Components of the QI Program Sample Clauses

Specific Required Components of the QI Program a. The Health Plan’s governing body shall oversee and evaluate the QI program. The role of the Health Plan’s governing body shall include providing strategic direction to the QI program, as well as ensuring the QI plan is incorporated into operation throughout the Health Plan. The written QI plan shall clearly describe the mechanism within the Health Plan for strategic direction from the governing body to be provided to the QI program and for the QI program committee to communicate with the governing body. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract b. The Health Plan shall have a QI program committee. The Health Plan’s medical director shall either chair or co-chair the committee. Other committee representatives shall be selected to meet the needs of the Health Plan but must include: 1) the quality director; 2) the grievance coordinator; 3) the utilization review manager; 4) the credentialing manager; 5) the risk manager/infection control professional (if applicable); and 6) provider representation, either through providers serving on the committee or through a provider liaison position, such as a representative from the network management department. Individual staff members may serve in multiple roles on the committee if they also serve in multiple positions within the Health Plan. The Health Plan shall have a mechanism to encourage enrollees to have input into activities conducted by the QI program committee. The committee shall meet no less than quarterly. Its responsibilities shall include the development and implementation of a written QI plan, which incorporates the strategic direction provided by the governing body. The QI plan shall contain the following components: (1) The Health Plan’s guiding philosophy for quality management and should identify any nationally recognized, standardized approach that is used (for example, PDCA, Rapid Cycle Improvement, FOCUS-PDCA, Six Sigma, etc.). Selection of performance indicators and sources for benchmarking also shall be described; (2) A description of the Health Plan positions assigned to the QI program, including a description of why each position was chosen to serve on the committee and the roles each position is expected to fulfill. The resumes of QI program committee members shall be made available upon the Agency’s request; (3) Specific training about quality that will be provided by the Health Plan to staff serving in the QI program. At a minimum the training shall include protocols d...
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