Quality Management (QM)
Improving quality of care for members, managing risk, and responding to member appeals and grievances.
To ensure our members receive exceptional care, QM continuously identifies, evaluates, and improves quality of service, quality of care, safety of care, access to care, and continuity of care for members of our networks.
In 2020, QM directly impacted the lives of 7,741 members by facilitating preventative health and was recognized by the National Committee for Quality Assurance for successfully completing the NCQA-Certified Align. Measure. Perform (AMP) Audit Review.
QM’s responsibilities include:
- Improving the health, wellbeing, and quality of life for members
- Provider and member engagement and education
- Partnering with health plans and reviewing patient charts to identify gaps-in-care and coding opportunities
- Collaborating with Health Plans to investigate and resolve all member initiated appeals and grievances.
- Administering the QICs in all markets
