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: A. The need for and approval of any changes in UM policies, standards, and procedures, including approval and implementation of clinical guidelines, and approving and monitoring the UM program description and work plan. ▇. ▇▇▇▇▇▇▇▇▇▇ and Appeals (including expedited Appeals and State Fair Hearings) related to UM activities to determine any needed policy changes.
Appears in 3 contracts
Sources: Medicaid Managed Care Contract, Medicaid Managed Care Contract, Medicaid Managed Care Contract
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:
A. The need for and approval of any changes in UM policies, standards, and procedures, including approval and implementation of clinical guidelines, and approving and monitoring the UM program description and work plan.
▇. ▇▇▇▇▇▇▇▇▇▇ B. Grievances and Appeals (including expedited Appeals and State Fair Hearings) related to UM activities to determine any needed policy changes.
Appears in 1 contract
Sources: Medicaid Managed Care Contract