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Utilization Management
Molina’s UM Department is designed to provide comprehensive health care management by managing utilization services and benefits effectively and efficiently. UM Decision Making Molina follows a h...
/providers/ca/marketplace/resource/utilized_mgt.aspx
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Rights & Responsibilities
Member Rights Members have the right to be treated with respect and recognition of their dignity by everyone who works with MHC. Member...
/providers/ca/medicaid/policies/rights.aspx
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Provider Dispute
PROVIDER Claim Disputes- THE “APPEALS PROCESS”   A Provider/Practitioner grievance or complaint is described in Title 22, California Code of Regulations (CCR), as a written entry into the appeals proc...
/providers/ca/medicaid/policies/provider-dispute.aspx
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ltss
Long term services and supports are Medi-Cal benefits that help members with ongoing personal care needs. Molina will work with the member's doctors and long term services and supports providers to ar...
/providers/ca/medicaid/Copy-resource/ltss.aspx
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Your Rights as a Molina Healthcare Member
Did you know that as a member of Molina Healthcare, you have certain rights and responsibilities? Knowing your rights and responsibilities will help you, your family, your provider and Molina Healthca...
/members/ca/mem/marketplace/quality/rights.aspx
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Reclamos y apelaciones
Como miembro de Molina Healthcare, si tiene un problema con su atención médica o nuestros servicios, tiene el derecho de presentar una reclamación (queja) o una apelación. Algunos ejemplos son: La ate...
/members/ca/mem/marketplace/quality/gna.aspx
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Complaints and Appeals
As a Molina Healthcare member, if you have a problem with your medical care or our services, you have a right to file a complaint (grievance) or appeal. Some examples are:   The care you get from...
/members/ca/mem/marketplace/quality/gna.aspx
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QI Accountability
 Organizational Structure Supporting Quality Improvement: AccountabilityThe Board of DirectorsMolina Healthcare of Michigan's Board has ultimate authority and responsibility for the quality of care an...
/providers/ca/marketplace/resource/qi_account.aspx
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Scope of Program Activities
The Molina Healthcare QI Program encompasses the quality of acute, chronic and preventive health care and service provided in both the inpatient and outpatient setting to our population as determined ...
/providers/ca/marketplace/resource/qi_scope.aspx
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QI Strategy
Quality Improvement Activities To meet the purpose, goals and scope of this program, QI activities as reflected in the QI Work Plan will be focused in the following areas.Improvement of the health sta...
/providers/ca/marketplace/resource/qi_strategy.aspx
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