UM100 – Qualifications for Staff Engaged in Utilization Management Activities
Form
This document outlines the qualifications required for staff involved in Utilization Management (UM) activities at Colorado Access. It details the clinical qualifications necessary for review staff, including specific licensure requirements for medical, nursing, pharmacy, and behavioral health professionals. The policy emphasizes the importance of qualified personnel in making healthcare utilization review determinations. Additionally, it ensures that no financial incentives are given that might affect the quality of care. Compliance and verification processes for staff credentials are also addressed.