Provider Manual

ORGANIZATIONAL STRUCTURE, ROLES AND RESPONSIBILITIES

Within each county structure there is a HealthChoices Governing Board. The HealthChoices Governing Board has ultimate responsibility for assuring a flexible, comprehensive and integrated Quality Management Program. The Governing Board assumes responsibility for assuring that the Quality Management Program is implemented and maintained. The Governing Board delegates responsibility for the Quality Management Program, and has the necessary authority to take appropriate actions to the Program Executive Director whom, in turn, delegates this responsibility and authority to the Quality Management/ Utilization Management Committee (QM/UMC). The Quality Management / Utilization Management Committee is comprised of at least the following persons:

• Clinical Department (e.g., Medical Director, Clinical Director, Team Leads)
• Quality Management Director
• County Representatives
• Consumer Representatives
• Provider Representatives

The QM/UMC meets on a quarterly basis. The Quality Management Director, or designee, records minutes at each QM/UMC meeting. The minutes include: the names of members in attendance, and the names of members absent; the date and time of the meeting; agenda items; discussion; and action items, including the responsible persons and the target completion dates.