Computer Systems
the system that IlliniCare uses to obtain prints from the copier. It can also be used to scan, and email documents.
What is Badge Print
The city that Centene corproate is located
What is St Louis
A process established by managed care to: determine medical necessity and ensure the highest quality of care. It helps determine the most appropriate setting of care and obtain the most reasonable cost.
What is Utilization Management (UM)
Provides team support and reaches out to members with health and preventive care information
What is a Program Coordinator
These documents are typically drafted from the contract based on our contractual obligations and dictate how we run our business (specifically Medical Management) from day to day
What is P&P (policy and procedures)
This system houses important updates about our parent company Centene.
What is CNET
The Senior Director of Human Resources, located in our Westmont Office.
Who is Barbara Basham
What is Care Coordination
Works with members, care givers and the community to set up resources that support the members identified needs
What is a Social Worker/ Program Specialist
This is a basic set of questions asked to members to evaluate their level of needs as it relates to their physical and behavioral health
What is a HRS (Health Risk Screening)
The information that comes from this database is state approved, member facing medical information that can be mailed.
What is KRAMES on demand
The year IlliniCare was established
What is Care (Case) Management
The highest level of care, risk stratifciaton/population management spectrum
What is Complex Care Management
Provides for the delivery of Medicaid health benefits and additional services through contracted arrangements with the state
What is a MCO (Managed Care Organization)
This is a our Electronic Medical Records system.
What is TruCare
The Chief Executive Office of IlliniCare. Housed out of Westmont and Wacker, but proudly from Centene's Peach State plan
Who is Leslie Naamon
Works together to find the best health solutions for member
What is Integrated Care Team
Adult Day Service, Homemaker Service, Emergency Home Response System
What are Waiver Services
This accreditatiting body exists to improve the quality of health care.
What is NCQA (National Committee for Quality Assurance)
This is a program inside of our EMR system that allows the viewer to see HEDIS information and gives insight on what care gaps need to be closed with each member
What is Interpreta
The number of facilities in the IlliniCare network (based on the slides that were presented)
What is 175
Montoring the care of members, grievances and appeals, performance measures, accreditation and complaince.
What is Quality Improvement
Assist members with achieving the highest possible level of wellness, functioning, independence, and quality of life
What is one of the goals of the Medical Management department
A widely used set of performance measures in the managed care industry, developed to maintained by NCQA.
What is HEDIS (Healthcare Effectiveness Data and Information Set)