Utilization Management Committee Sample Clauses

Utilization Management Committee. The Contractor shall establish an internal UM Committee, including Kentucky-based provider representation, that focuses on oversight of clinical service delivery trends across its membership, including evaluating utilization, patterns of care, and key utilization indicators. The Contractor’s Medical Director shall chair or co-chair the UM Committee report findings to the Quality Improvement Committee. The UM Committee shall review, at a minimum:
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Utilization Management Committee. The committee shall have written parameters for operating and will meet on a regular schedule, defined to be at least quarterly. Committee members shall be clearly identified and representative of the contractor's providers, accountable to the medical director and governing body, and shall maintain appropriate documentation of the committee's activities, findings, recommendations, and actions.
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Utilization Management Committee. UMC). A committee operating within HFC whose function is to ensure both quality and cost-effectiveness of treatment.
Sample 1
Utilization Management Committee. The Contractor must have a utilization management committee directed by the Contractor’s Medical Director. The committee shall be responsible for:  Monitoring providers’ requests for rendering health care services to its members;  Monitoring the medical appropriateness and necessity of health care services provided to its members;  Reviewing the effectiveness of the utilization review process and making changes to the process as needed;  Writing policies and procedures for utilization management that conform to industry standards including methods, timelines and individuals responsible for completing each task; and  Confirming the Contractor has an effective mechanism in place for a plan provider or Contractor representative to respond within one hour to all emergency room providers twenty four (24)-hours-a-day, seven (7)-days-a-week:  After the Contractor’s member’s initial emergency room screening; and,  After the Contractor’s member has been stabilized and the emergency room provider believes continued treatment is necessary to maintain stabilization.
Sample 1
Utilization Management Committee. The Contractor shall have a utilization management committee directed by the Contractor’s Medical Director. The same committee may be responsible for all State Medicaid lines of business. The committee shall be responsible for:  Monitoring providers’ requests for rendering health care services to its members;  Monitoring the medical appropriateness and necessity of health care services provided to its members;  Reviewing the effectiveness of the utilization review process and making changes to the process as needed;  Writing policies and procedures for utilization management that conform to industry standards including methods, timelines and individuals responsible for completing each task; and  Confirming the Contractor has an effective mechanism in place for a plan provider or Contractor representative to respond within one hour to all emergency room providers twenty four (24)-hours-a-day, seven (7)-days-a-week:  After the Contractor’s member’s initial emergency room screening; and,  After the Contractor’s member has been stabilized and the emergency room provider believes continued treatment is necessary to maintain stabilization.
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Utilization Management Committee. (Operations Committee) Reports to the ACO’s Board of Managers Objectives  Review of financial and utilization data practices of the network physicians; makes recommendations to the ACO Board regarding improvement opportunities and practices. 1. Xxxxxxxxx Xxxxxx, M.D., DuPage Medical Group, Ltd. 2. Xxx Xxxxxx, M.D., Elmhurst Memorial Healthcare 3. Xxxxx Xxxxx, M.D., DuPage Medical Group, Ltd. 4. Xxxxx-Xx Xxxx, M.D., Xxxxxx Medical Group 5. Xxxxx Xxxxx, M.D., Independent Physician Practice Participant 6. Xxxxxx Xxxx, M.D., DuPage Medical Group, Ltd. 7. Xxxxxx Xxxxxxx, M.D., Elmhurst Memorial Healthcare 8. Xxxxxxx Xxxxxxxxxx, M.D., Medical Director, Illinois Health Partners ACO, DuPage Medical Group, Ltd. 9. Xxxxx Xxxxxxxxx, M.D., Xxxxxx Medical Group 10. Xxxxxxx Xxxxx, M.D., Elmhurst Memorial Healthcare 11. Xxxxxxxx Xxxxxxx, M.D., DuPage Medical Group, Ltd. 12. Xxxxx Xxxxx, M.D., Linden Oaks Hospital 13. Xxxx Xxxx, M.D., DuPage Medical Group, Ltd. 14. Xxxxx Xxxxxx, M.D., Xxxxxx Health Ventures 15. Xxx Xxxxxxx, M.D., Xxxxxx Medical Group 16. Xxxxx Xxxxx, M.D., Independent Physician Practice Participant 17. Xxxxx Xxxxxx, M.D., Elmhurst Memorial Hospital Name of Committee/Duties Members
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Utilization Management Committee. The Federation shall designate one RNCM and one alternate RNCM to be a delegate during the administrative portion of the Utilization Management Committee. The purpose of the RNCM delegate shall be to provide additional insight and expertise on relevant Utilization Management issues and to assist the Department Manager in communicating with others.”
Sample 1
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Utilization Management Committee. The MCO must have a utilization management committee directed by the MCO’s Medical Director. The committee is responsible for: • Monitoring the MCO’s provider’s requests for rendering medically appropriate and necessary health care services to its members • Reviewing the effectiveness of the utilization review process and making changes to the process as needed HOOSIER HEALTHWISE STATE/MCO CONTRACT CONTRACT ATTACHMENT 1: MCO SCOPE OF WORK • Writing policies and procedures for utilization management that conform to industry standards including methods, timelines and individuals responsible for completing each task • Confirming the MCO has an effective mechanism in place to respond within one hour to all emergency room providers 24-hours-a-day, seven-days-a-week: • After the MCO’s member’s initial emergency room screening, and • After the MCO’s member has been stabilized and the emergency room provider believes continued treatment is necessary to maintain stabilization. OMPP may waive certain administrative requirements, including prior authorization procedures, to the extent that such waivers are allowed by law and are consistent with policy objectives. The MCO may be required to comply with such waivers and will be provided with prior notice by OMPP.
Sample 1
Utilization Management Committee. Medical Group shall establish and maintain a Utilization Management Committee consisting of at least three (3) Medical Group Physicians. The Utilization Management committee shall meet as frequently as necessary but at least bi-weekly and shall keep minutes of the committee meetings, copies of which shall be made available for review by PacifiCare from time to time upon request. The confidentiality of all such minutes shall be protected to the fullest extent consistent with applicable law. Medical Group agrees that, when appropriate and upon reasonable notice, PacifiCare's Medical Director or a member of the PacifiCare medical services staff may participate in Medical Group Utilization Management Committee meetings during the discussion of matters relating to medical care provided to PacifiCare Members.
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Related to Utilization Management Committee

  • Management Committee The Members shall act collectively through meetings as a "committee of the whole," which is hereby named the "Management Committee." The Management Committee shall conduct its affairs in accordance with the following provisions and the other provisions of this Agreement:

  • Advisory Committee The Settling State shall designate an Opioid Settlement Remediation Advisory Committee (the “Advisory Committee”) to provide input and recommendations regarding remediation spending from that Settling State’s Abatement Accounts Fund. A Settling State may elect to use an existing advisory committee or similar entity (created outside of a State-Subdivision Agreement or Allocation Statute); provided, however, the Advisory Committee or similar entity shall meet the following requirements:

  • Steering Committee The Project Manager shall set up a Steering Committee for the Project, consisting of representatives from the Department, the Contractor, and any other key organisations whom the project will impact on, to be agreed between the parties. The function of the Steering Committee shall be to review the scope and direction of the Project against its aims and objectives, monitor progress and efficiency, and assess, manage and review expected impact and use of the findings from the Project. The Committee shall meet at times and dates agreed by the parties, or in the absence of agreement, specified by the Department. The Contractor’s representatives on the Steering Committee shall report their views on the progress of the Project to the Steering Committee in writing if requested by the Department. The Contractor’s representatives on the Steering Committee shall attend all meetings of the Steering Committee unless otherwise agreed by the Department.

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