Attachment J.19 - Quarterly Staffing Report Template.xlsx
XLSX spreadsheet 19 KB Posted
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- World Trade Center Health Program Clinical Centers of Excellence (CCE) - Draft Solicitation
- Solicitation number
- Draft_75D301-22-R-72142
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Sheet1 Quarterly Staffing Report for Option Period: XXXX Dates (xx/xx/xx - xx/xx/xx)
| Contract #: (enter contract number) Fringe Rate_______ Approved FTE_____ | ||||||||||
| Note: List vacancies at the top of the spreadsheet, followed by New Hires in Red text, and list subcontractors at bottom of spreadsheet | ||||||||||
| Start Date | Vacancy Date | Facility | Activity Codes | WTC Billing Labor Category | Employee Name | Sub-Contractor (Y/N) | Salary | % of Effort | Comments | |
| 0 |
Sheet2
| Activity Code | WTC Billing Labor Category | |
| 4.1 Contract Management (Directors only for this activity) | Administrative Assistant | |
| 4.1.1 Training | Administrative Coordinator | |
| 4.1.1.1 Training Reporting | Benefits Coordinator | |
| 4.1.2 Staffing Requirements | Case Management | |
| 4.1.2.1 Staffing Report and Wages Report | Claims/Billing Manager | |
| 4.1.3 Coordination and Participation | Claims/Billing Specialist | |
| 4.1.4 Change Request (CR), Documentation, and Control Log | Clinic Manager | |
| 4.1.5 Technical Guidance Document Compliance | Data Analyst | |
| 4.1.6 Records Management | Deputy Director | |
| 4.1.7 Risk and Issue Management | Director | |
| 4.1.8 Fraud Waste and Abuse Compliance | Finance Specialist | |
| 4.1.9 Quality Assurance Plan | yes | Information Technology |
| 4.1.9.1 Quality Assurance Internal Audit Report | no | Medical Assistant |
| 4.2 Systems | Medical Records Coordinator | |
| 4.2.1.2 Member Records | Member Services Coordinator | |
| 4.2.2 Cost Tracking and Invoicing | Member Services Manager | |
| 4.2.3 Operations Manual | Nurse | |
| 4.3.1 Member Services | Nurse Manager | |
| 4.3.2 Member Enrollment and Initial Contact | Pharmacist | |
| 4.3.3 Member Retention | Physician | |
| 4.3.4 Transfers | Physician Assistant | |
| 4.3.5 Disruptive member and Member in Crisis Protocol | Project Coordinator | |
| 4.3.6 Benefits Counseling | Psychiatrist | |
| 4.3.6.1 Social Benefits Functions | Psychologist | |
| 4.3.6.2 Assistance with Workers Compensation and other Healthcare Benefits | Pulmonologist | |
| 4.3.7 Communication | Quality Assurance | |
| 4.3.7.1 Translation and Interpretive Services | Revised Title | |
| 4.3.7.2 Retention Activities for Current Members | Social Worker | |
| 4.3.7.3 Outreach and Education for Prospective Members | ||
| 4.3.7.4 Establish Formal Mechanism for Consulting with Representative of Eligible Populations | ||
| 4.3.8 Administering Health Benefits | ||
| 4.3.8.1 Responsibilities of the Medical Director | ||
| 4.3.8.1.1 External Providers | ||
| 4.3.8.2 Responsibilities of the Mental Health Director | ||
| 4.3.8.3 Monitoring and Initial Health Evaluations | ||
| 4.3.8.3.1 Initial Health Evaluations | ||
| 4.3.8.3.2 Annual Monitoring Exam | ||
| 4.3.8.3.3 General Administration for AME/IHE | ||
| 4.3.8.4 Diagnostic Services | ||
| 4.3.8.6 Cancer Screening | ||
| 4.3.8.7 Certifications | ||
| 4.3.9 Medical Treatment for Certified Conditions | ||
| 4.3.9.1 Authorization of Services | ||
| 4.3.9.3 Prior Authorization] | ||
| 4.3.9.4 CCE Medical Reviews | ||
| 4.3.9.5 Medical Appeals | ||
| 4.3.9.6 Telehealth Services | ||
| 4.3.9.7 Disaster Preparedness and Public Health Emergencies | ||
| 4.4 Comprehensive Care Management (do not use, select sub-category) | ||
| 4.4.1 Case Management and Care Coordination | ||
| 4.4.1.1 Intensive Case Management | ||
| 4.4.2 Utilization Management | ||
| 4.4.3 Inpatient Hospital stays | ||
| 4.4.4 Lifestyle Medicine | ||
| 4.5 Claims submission and Payment | ||
| 4.5.1 Legally allowable fee schedule | ||
| 4.5.2 Billing for Health Plan Benefits | ||
| 4.5.3 Claims Appeals | ||
| 4.5.4 Coordination of Benefits (Survivor Cohort Only) | ||
| 4.6 Pharmacy Services | ||
| 4.6.1 Member Education | ||
| 4.6.2 Covered Medication and Restrictions | ||
| 4.6.3 Review of Data | ||
| 4.6.4 Compliance with State and Federal Law | ||
| 4.6.5 Retrospective Reviews and Reporting | ||
| 4.6.6 Pharmacy Benefits Quality Assurance and Reporting | ||
| 4.7.1 Provider Network | ||
| 4.7.2 Licensing and Insurance | ||
| 4.8 Transitioning Out | ||
| 5.1 Data Management Plan | ||
| 5.2 Data Transfer | ||
| 6 Performance Metrics | ||
| 6.1 Quality Assurance Surveillance Plan | ||
| 9 Deliverables | ||
| 10 Subcontracting | ||
| 11 HIPAA COMPLIANCE AND BUSINESS ASSOCIATE AGREEMENT | ||
| 12 Information Security | ||
| 12.1 Adequate Security | ||
| 12.2 Cyber Incident Reporting Requirement | ||
| 12.3 Cyber Incident Report | ||
| 12.4 Media Preservation and Protection | ||
| 12.5 Audit and Accountability (information security) | ||
| 12.6 Information Security Continuous Monitoring | ||
| 12.7 Access to Additional Information or Equipment Necessary for Forensic Analysis | ||
| 12.8 Cyber Incident Damage Assessment Activities | ||
| 12.9 CDC/NIOSH Safeguarding and Use of Contractor Attributional/Proprietary Information (do not use) | ||
| 12.1 Use and Release of Contractor Attributional/Proprietary Information Not Created By or For CDC/NIOSH (Do not use) | ||
| 12.11 Use and Release of Contractor Attributional/Proprietary Information Created By or For CDC/NIOSH (do not use) | ||
| 12.12 Use and Release of Contractor Attributional/Proprietary Information Created By or For CDC/NIOSH (do not use) | ||
| 12.13 Other Safeguarding or Reporting Requirements | ||
| 12.14 Subcontracts |
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