RRM Category: ADMINISTRATION
RRM Module: Contract Health Services
Overview:
The RRM Contract Health Services (CHS) staffing module estimates the requirements for CHS staff to include: CHS Supervisor, Utilization Review, and CHS Staff. The CHS staff performs the day-to-day management functions of the contracted health services program for the facility. The workload parameter that is the key variable is number of CHS authorizations for health care for eligible individuals.
Services Description:
The CHS staff performs the following activities:
Patient eligibility for contract health care
Processing procurement orders for requested contract health services
Tracking allocation of CHS funds to assure the program stays within budget
Coordination of activities associated with contract health care
Staffing Criteria:
Fixed CHS Manager staff of 1.0 FTE for each facility that processes 100 or more CHS authorizations for health care services.
Utilization Review staff of 1.0 FTE for every 10,000 CHS authorizations for health care services.
CHS Staff of 1.0 FTE for every 2,000 CHS authorizations for health care services at facilities that have over 100 CHS authorizations a year.
STAFFING FORMULAE
Personnel Categories:
CHS Manager
Utilization Review
CHS Staff
Driving Variables:
CHS Authorizations
MINIMUM STAFFING LEVELS (fixed):
| Personal Category |
FTEs |
Per |
Driving Variables |
Min. |
Max. |
|
CHS Manager
|
1
|
Per facility
|
|
100
|
|
Plus, VARIABLE STAFFING LEVELS:
| Personal Category |
FTEs |
per |
Driving Variables |
Min. |
Max. |
|
Utilization Review
|
1
|
10,000
|
CHS Authorizations
|
0
|
n/a
|
|
CHS Staff
|
1
|
2000
|
CHS Authorizations
|
100
|
n/a
|
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| 
