Utilization Management Director Sample Clauses

Utilization Management Director. The Utilization Management Director must: Be an Ohio-licensed registered nurse or a physician with a current unencumbered license through the Ohio State Medical Board with experience in the activities of utilization management, in accordance with 42 CFR 438.210; Preferably be certified as a Certified Professional in Health Care Quality by the NAHQ and/or CHCQM by the American Board of Quality Assurance and Utilization Review Providers; and Report through the Medical Director/CMO. The Utilization Management Director's primary responsibilities are to: Oversee the day-to-day operational activities of the Utilization Management Program in accordance with state guidelines; Develop written policies and procedures regarding authorization of services and monitor to ensure that these are followed; Ensure the consistent application of review criteria for authorization decisions; Ensure that decisions to deny or reduce the amount of services are made by a health care professional who has appropriate clinical expertise in treating the member's condition or disease; Ensure MCO Notices of Adverse Action are provided in accordance with 42 CFR 438.404; Ensure that all authorization decisions are made within the specified allowable timeframes; and Evaluate under and over utilization information for impact on member quality of care and outcomes, including access to care.
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Utilization Management Director. The Utilization Management Director must:
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Utilization Management Director. 1. The Utilization Management Director must: Be an Ohio-licensed registered nurse, APRN, licensed independent behavioral health clinician (MD, DO, RN with Advance Practice Registered Nurse [APRN] licensure, psychologist, licensed independent social worker [LISW], professional clinical counselor [LPCC], independent marriage and family therapist [LIMFT]) with a current unencumbered license through the Ohio State Medical Board with experience in the activities of utilization management, in accordance with 42 CFR 438.210. The Utilization Management Director must have at least three years' experience providing direct behavioral health care coordination or oversight for children and adolescents with complex behavioral health needs; Preferably be certified as a Certified Professional in Health Care Quality by the NAHQ or CHCQM by the American Board of Quality Assurance and Utilization Review Providers; and Report through the Medical Director/CMO. The Utilization Management director can be located out of state if prior approved by ODM. Upon ODM approval, any out of state Utilization Management Director hire must meet Ohio licensing requirements within 6 months of hire.
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Utilization Management Director 
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Related to Utilization Management Director

  • Utilization Management Contractor shall maintain a utilization management program that complies with applicable laws, rules and regulations, including Health and Safety Code § 1367.01 and other requirements established by the applicable State Regulators responsible for oversight of Contractor.

  • Union-Management Committee There shall be a union/management committee comprised of four (4) employee representatives appointed by the Union and four (4) employer representatives. The Committee's purpose is to provide and promote effective and meaningful communication of information and ideas and to make joint recommendations on matters of concern. Matters that are properly the subject of an individual grievance will not be discussed at this committee. The Committee will meet quarterly, unless agreed otherwise, at a time and place mutually agreed to provided there is business for their joint consideration. The parties will exchange agenda items at least one (1) week prior to the meeting. The parties further agree the Committee may meet at any time its members mutually agree a meeting should be held. The duties of the Chairperson will be shared by the parties. Copies of the minutes shall be provided to Committee members. The employer agrees to pay for time spent during regular working hours for representatives of the union attending such meetings. The parties may utilize video or teleconferencing services for the purposes of committee members attending committee meetings, where appropriate and available. Neither party can unreasonably deny an initiative to utilize video or teleconferencing services.

  • Labour Management Relations Committee 20.01 The parties recognize that a forum for ongoing discussions during the term of the Agreement can promote more harmonious labour relations between them.

  • EMPLOYEE-MANAGEMENT ADVISORY COMMITTEE 33.01 (a) An Employee-Management Advisory Committee (EMAC) shall be established within three (3) months of the signing of the Collective Agreement. The Union Representative shall provide the names of up to three (3) elected Employees and the Employer shall provide the names of up to three (3) appointed representatives to sit on the EMAC.

  • Labour Management Committee (a) Where the parties mutually agree that there are matters of mutual concern and interest that would be beneficial if discussed at a Labour-Management Committee Meeting during the term of this Agreement, the following shall apply.

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