N.J. Rev. Stat. § 26:2S-6. Managed care plan carriers; medical directors: Health Care Quality Act – New Jersey

Status: Enacted
Year Enacted: 1997
Year Amended: 1998
File: Download

A carrier which offers a managed care plan or uses a utilization management system in any of its health benefits plans shall designate a licensed physician to serve as medical director. The medical director shall ensure that any utilization management decision to deny, reduce or terminate a health care benefit or to deny payment for a health care service, because that service is not medically necessary, shall be made by a physician. See definition section N.J. Rev. Stat. § 26:2S-2.

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