Health Services

Utilization Management

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The Utilization Management (UM) Program is designed to manage the use of health care resources and to maximize the effectiveness and quality of the care provided to our enrolled Members. The Program also defines the process and structure whereby Medical Management staff and the Delegation Oversight Committee (DOC) conducts oversight of delegated activities. The Utilization Management Program interfaces with the plan’s quality management system to facilitate the achievement of its goals and objectives.

Download Utilization Management Program Description
Download 2023-24 Utilization Management Policy
Download 2023-24 UM Referrals Policy
Download 2023-24 UM Continuity of Care Policy

Quality Improvement Health Equity Committee (QIHEC)

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The Quality Improvement Health Equity Committee (QIHEC) is responsible for oversight of the Community Health Plan of Imperial Valley’s (CHPIV) Quality Improvement and Health Equity efforts.

Meetings to begin at the end of Q1 2024. Meeting minutes will be made available here.

Download QIHEC Description
Download QIHE Program Description
Download QIHE Workplan