Common use of Utilization Management Manager Clause in Contracts

Utilization Management Manager. The Contractor must employ a Utilization Management Manager who is dedicated full-time to the PathWays program. The Utilization Management Manager shall be responsible for directing the activities of the utilization management staff. With direct supervision by the Medical Director and a staff geriatrician, the Utilization Management Manager shall direct staff performance regarding prior authorization, medical necessity determinations, concurrent review, retrospective review, appropriate utilization of health care services, continuity of care, and other clinical and medical management programs. The Utilization Management Manager shall work with the Special Investigation Unit (SIU) Manager to assure that service billing and utilization issues are documented and reported to the SIU, and matters requiring SIU review or investigation shall be timely submitted within five (5) business days to enable recovery of overpayments or other appropriate action. For more information regarding the utilization management requirements, see Section 7.8. The Utilization Management Manager shall have prior experience in LTSS or with the program population.

Utilization Management Manager. The Contractor must shall employ a Utilization Management Manager who is dedicated full-time to the PathWays programfull- product lines. The Utilization Management Manager shall shall, at a minimum, be responsible for directing the activities of the utilization management staff. With direct supervision by the Medical Director and a staff geriatricianDirector, the Utilization Management Manager shall direct staff performance regarding prior authorization, medical necessity determinations, concurrent review, retrospective review, appropriate utilization of health care services, continuity of care, care coordination and other clinical and medical management programs. The Utilization Management Manager shall work with the Special Investigation Unit (SIU) Manager to assure that service billing and utilization issues are documented and reported to the SIU, and matters requiring SIU review or investigation shall be timely submitted within five (5) business days to enable recovery of overpayments or other appropriate action. For more information regarding the utilization management requirements, see Section 7.8. The Utilization Management Manager shall have prior experience in LTSS or with the program population6.