Care Management Program definition

Care Management Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.
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Care Management Program. (CMP) means the process, methods and activities to identify high/need high/cost SMI members receiving physical health services and designing clinical interventions or alternative treatment to reduce risk, cost and help members achieve better health care outcomes.
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Care Management Program means the program maintained by ECI pursuant to which ECI provides Care Management Services.
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Examples of Care Management Program in a sentence

  • Xxxxxx Permanente will offer a comprehensive Employee Health Care Management Program to help employees manage their chronic diseases and other existing health issues.

  • The Employee Health Care Management Program will be integrated with existing care management and employee health programs at the local level.

  • The parties will jointly design an Employee Health Care Management Program, and prepare an implementation plan to include a staffing plan, in the first year of the Agreement.

  • This section tells you about the CO-OP’s Care Management Program.

  • The CO-OP’s Care Management Program, using the services of professional medical peer review committees, utilization review committees, and/or the Medical Director, determines whether services and supplies are Medically Necessary.

  • The CO-OP’s Care Management Program requires the Member, Plan Providers and the CO-OP to work together.

  • There will be no charge to a Member when seeking a second opinion for surgical or specialty services who has received Prior Authorization from the CO-OP’s Care Management Program.

  • Failure to comply with the rules of the CO-OP’s Care Management Program means the Member will be responsible for costs of services received.

  • The CO-OP’s Care Management Program helps direct care to the most appropriate setting to provide healthcare in a cost-effective manner.

  • When required, compliance by the Member with the CO-OP’s Care Management Program is mandatory.

Related to Care Management Program

  • Health plan or "health benefit plan" means any policy,

  • Service Management System (SMS) means an off-line system used to access, create, modify, or update information in a Database.

  • Database Management System (“DBMS”) is a computer process used to store, sort, manipulate and update the data required to provide Selective Routing and ALI.

  • Case management means a care management plan developed for a Member whose diagnosis requires timely coordination. All benefits, including travel and lodging, are limited to Covered Services that are Medically Necessary and set forth in the EOC. KFHPWA may review a Member's medical records for the purpose of verifying delivery and coverage of services and items. Based on a prospective, concurrent or retrospective review, KFHPWA may deny coverage if, in its determination, such services are not Medically Necessary. Such determination shall be based on established clinical criteria and may require Preauthorization.