CCM Certification Study Guide 2025-2026 - Case Manager Exam
Prep Secrets [7th Edition]
CCM Certification Study Guide 2025–2026 — Questions 1–30
I. Case Management Principles
1. The primary role of a case manager is to:
A) Coordinate care to improve patient outcomes and manage resources
B) Diagnose medical conditions
C) Prescribe medications
D) Perform surgical procedures
✔ Correct Answer: A — Coordinate care to improve patient outcomes and manage resources
Rationale: Case managers facilitate care, reduce fragmentation, and ensure cost-effective, quality
care.
2. Care coordination involves:
A) Organizing patient care across providers and settings
B) Performing medical tests
C) Managing only hospital staff
D) Ignoring patient preferences
✔ Correct Answer: A — Organizing patient care across providers and settings
Rationale: Effective coordination ensures continuity and avoids duplicative services.
3. A key component of case management includes:
A) Assessment, planning, implementation, monitoring, and evaluation
B) Only financial auditing
C) Scheduling staff exclusively
D) Performing all treatments personally
✔ Correct Answer: A — Assessment, planning, implementation, monitoring, and evaluation
Rationale: These five steps constitute the standard case management process.
4. Which is an essential skill for case managers?
A) Communication and advocacy
B) Only clinical procedures
C) Surgery
D) Accounting only
✔ Correct Answer: A — Communication and advocacy
Rationale: Case managers must interact with patients, providers, and payers to ensure coordinated
care.
, 5. A case manager identifies gaps in care. Best next step:
A) Develop an intervention plan to address gaps
B) Ignore and continue current plan
C) Refer only to a social worker
D) Stop care coordination
✔ Correct Answer: A — Develop an intervention plan to address gaps
Rationale: Actionable interventions improve patient outcomes and reduce risk.
II. Clinical Knowledge
6. Chronic conditions commonly managed in case management include all EXCEPT:
A) Hypertension
B) Diabetes
C) Acute minor cuts
D) Heart failure
✔ Correct Answer: C — Acute minor cuts
Rationale: Case management focuses on complex, long-term conditions rather than minor acute
injuries.
7. Which assessment is part of the case manager’s role?
A) Functional, psychosocial, and environmental assessment
B) Only blood tests
C) Only imaging studies
D) Performing surgery
✔ Correct Answer: A — Functional, psychosocial, and environmental assessment
Rationale: Comprehensive assessments identify barriers and support needs for care planning.
8. Risk stratification in case management is used to:
A) Identify patients who need more intensive care
B) Determine billing codes only
C) Assign staff arbitrarily
D) Delay care
✔ Correct Answer: A — Identify patients who need more intensive care
Rationale: Stratifying risk ensures resources are allocated effectively for high-risk patients.
9. A case manager monitors medication adherence to:
A) Improve outcomes and prevent complications
B) Replace pharmacist responsibilities
C) Avoid documentation
D) Perform therapy
✔ Correct Answer: A — Improve outcomes and prevent complications
Rationale: Adherence monitoring reduces hospitalizations and improves chronic disease
management.
Prep Secrets [7th Edition]
CCM Certification Study Guide 2025–2026 — Questions 1–30
I. Case Management Principles
1. The primary role of a case manager is to:
A) Coordinate care to improve patient outcomes and manage resources
B) Diagnose medical conditions
C) Prescribe medications
D) Perform surgical procedures
✔ Correct Answer: A — Coordinate care to improve patient outcomes and manage resources
Rationale: Case managers facilitate care, reduce fragmentation, and ensure cost-effective, quality
care.
2. Care coordination involves:
A) Organizing patient care across providers and settings
B) Performing medical tests
C) Managing only hospital staff
D) Ignoring patient preferences
✔ Correct Answer: A — Organizing patient care across providers and settings
Rationale: Effective coordination ensures continuity and avoids duplicative services.
3. A key component of case management includes:
A) Assessment, planning, implementation, monitoring, and evaluation
B) Only financial auditing
C) Scheduling staff exclusively
D) Performing all treatments personally
✔ Correct Answer: A — Assessment, planning, implementation, monitoring, and evaluation
Rationale: These five steps constitute the standard case management process.
4. Which is an essential skill for case managers?
A) Communication and advocacy
B) Only clinical procedures
C) Surgery
D) Accounting only
✔ Correct Answer: A — Communication and advocacy
Rationale: Case managers must interact with patients, providers, and payers to ensure coordinated
care.
, 5. A case manager identifies gaps in care. Best next step:
A) Develop an intervention plan to address gaps
B) Ignore and continue current plan
C) Refer only to a social worker
D) Stop care coordination
✔ Correct Answer: A — Develop an intervention plan to address gaps
Rationale: Actionable interventions improve patient outcomes and reduce risk.
II. Clinical Knowledge
6. Chronic conditions commonly managed in case management include all EXCEPT:
A) Hypertension
B) Diabetes
C) Acute minor cuts
D) Heart failure
✔ Correct Answer: C — Acute minor cuts
Rationale: Case management focuses on complex, long-term conditions rather than minor acute
injuries.
7. Which assessment is part of the case manager’s role?
A) Functional, psychosocial, and environmental assessment
B) Only blood tests
C) Only imaging studies
D) Performing surgery
✔ Correct Answer: A — Functional, psychosocial, and environmental assessment
Rationale: Comprehensive assessments identify barriers and support needs for care planning.
8. Risk stratification in case management is used to:
A) Identify patients who need more intensive care
B) Determine billing codes only
C) Assign staff arbitrarily
D) Delay care
✔ Correct Answer: A — Identify patients who need more intensive care
Rationale: Stratifying risk ensures resources are allocated effectively for high-risk patients.
9. A case manager monitors medication adherence to:
A) Improve outcomes and prevent complications
B) Replace pharmacist responsibilities
C) Avoid documentation
D) Perform therapy
✔ Correct Answer: A — Improve outcomes and prevent complications
Rationale: Adherence monitoring reduces hospitalizations and improves chronic disease
management.
