Nursing Case Management Certification (CMGT-BC™)
Verified Questions & Correct Answers – A+ Graded – 2026/2027 Edition
150 Questions | 8 ANCC CMGT-BC Aligned Domains | Scenario-Based Items with Verified Rationales | Answer Key Included
SECTION 1 Case Management Foundations and Standards
Scope of Practice, Core Competencies, Models of Care, and Ethical Standards | Questions 1-20
Q1. Which of the following statements most accurately reflects the definition of case management as articulated by
the Commission for Case Manager Certification (CCMC)?
A. A collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for
options and services to meet an individual's comprehensive health needs through communication and available
resources. [CORRECT]
B. A payer-driven utilization review process that authorizes only medically necessary services while minimizing
plan expenditures.
C. A disease management protocol that standardizes care for specific diagnoses using evidence-based clinical
pathways.
D. A discharge documentation process completed at the end of an inpatient admission to arrange post-acute
services.
Correct Answer: A
Rationale: The CCMC definition centers case management as a collaborative, client-focused process spanning assessment,
planning, facilitation, care coordination, evaluation, and advocacy across the continuum. Options B and C describe narrower
functions such as utilization review and disease management, which are components or related disciplines but not the full
definition. Option D reduces case management to episodic discharge paperwork, ignoring its longitudinal, cross-setting
scope that the CMGT-BC role is expected to lead.
Q2. According to the CCMC Code of Professional Conduct, when the interests of the case manager's employer
conflict with the safety and welfare of the client, the case manager's primary professional obligation is to:
A. Follow the employer's cost-containment policies, because employment agreements take precedence over
individual client concerns.
B. Hold the client's safety, welfare, and best interests as the first priority while acting within the code's
provisions and applicable regulations. [CORRECT]
C. Defer to the ordering physician, because clinical decision-making authority rests solely with the medical
staff.
D. Approve half of the disputed services to balance financial and clinical concerns.
Correct Answer: B
Rationale: The CCMC Code of Professional Conduct directs case managers to advance quality client outcomes and to place
client safety and welfare above personal or financial interests, even within a payer or employer setting. Employer policies
are followed only to the extent that they do not compromise the client's best interests or violate the code. Automatically
deferring to physicians abdicates the advocacy duty, and arbitrarily splitting services is neither standards-based nor
defensible.
CMGT-BC Verified Questions and Correct Answers 1
,Nursing Case Management Certification (CMGT-BC) Exam Preparation 2026/2027 Edition
Q3. A newly hired case manager is building a professional development plan and wants the document that defines the
practice expectations, competencies, and processes for professional case management across all practice settings.
Which resource best meets this need?
A. The Medicare Conditions of Participation for discharge planning.
B. The ANCC test content outline for the CMGT-BC examination.
C. The Case Management Society of America's Standards of Practice for Case Management. [CORRECT]
D. The facility's internal utilization management policy manual.
Correct Answer: C
Rationale: The CMSA Standards of Practice for Case Management articulate the scope, competencies, and practice
expectations for case managers across settings and are widely used to structure professional development and quality review.
The Medicare Conditions of Participation are regulatory requirements for institutional discharge planning rather than a
broad practice framework. The ANCC test outline describes examination content only, and internal policy manuals are
facility-specific rather than professional standards.
Q4. In an integrated hospital case management department, a staff nurse asks how the case manager role differs from
the concurrent utilization review nurse role. The case manager's most accurate response is that case management is
distinguished by:
A. Authorizing admissions while the utilization review nurse coordinates discharge services.
B. Working only with managed care contracts, while the utilization review nurse works within the hospital.
C. Assigning nursing diagnoses, while the utilization review nurse assigns medical diagnoses.
D. Longitudinal coordination across the continuum, including advocacy, transition planning, and linking the
client to resources, rather than episodic review of a single admission. [CORRECT]
Correct Answer: D
Rationale: Case management is a longitudinal, cross-continuum process that integrates assessment, care planning,
advocacy, transitions, and resource linkage for the client over time. Concurrent utilization review is an important supporting
function focused on medical necessity and level of care during a specific episode. The other options misstate the roles or
incorrectly separate coordination from the core case management function.
Q5. Which step comes first in the case management process as described by the Commission for Case Manager
Certification?
A. Assessing
B. Stratifying risk
C. Screening [CORRECT]
D. Planning
Correct Answer: C
Rationale: The CCMC case management process begins with screening to identify individuals who may benefit from case
management services, using referral data, utilization reports, and risk flags. Assessment, risk stratification, and planning
follow once a candidate has been identified and engaged. Sequencing matters because unsafe or inefficient plans result when
planning precedes assessment, and assessment cannot occur before candidates are identified.
CMGT-BC Verified Questions and Correct Answers 2
,Nursing Case Management Certification (CMGT-BC) Exam Preparation 2026/2027 Edition
Q6. A case manager receives referrals for four clients. Which client is most appropriate for assignment to intensive,
high-touch case management based on risk stratification principles?
A. A 67-year-old with heart failure, chronic kidney disease, depression, three hospitalizations in 6 months, and
unstable housing. [CORRECT]
B. A 34-year-old with well-controlled asthma who completed an annual wellness visit.
C. A 51-year-old with newly diagnosed hypertension prescribed a first-line agent who requires routine
monitoring.
D. A 45-year-old who calls the clinic monthly to request prescription refills on time.
Correct Answer: A
Rationale: Risk stratification uses clinical complexity, psychosocial barriers, prior utilization, and self-management
capacity to direct resources toward clients with the greatest need. This client combines multiple chronic conditions, a
behavioral health comorbidity, high prior utilization, and a social determinant barrier of unstable housing, all markers for
intensive case management. The other clients have stable, low-complexity profiles better served by population health
programs, standard monitoring, or brief interventions.
Q7. A medical-surgical registered nurse is interested in pursuing the ANCC Nursing Case Management board
certification (CMGT-BC). Which set of eligibility requirements must the nurse satisfy?
A. An active LPN or RN license, 1 year of nursing practice, and 500 case management hours within 2 years.
B. A master's degree in nursing, 3 years of RN practice, and 5,000 case management hours.
C. An active RN license and current employment as a case manager, with no minimum case management
practice hours.
D. An active RN license, 2 years of full-time practice as an RN, a minimum of 2,000 hours of clinical practice
in nursing case management within the last 3 years, and 30 continuing education hours in nursing case
management within the last 3 years. [CORRECT]
Correct Answer: D
Rationale: ANCC eligibility for the CMGT-BC credential requires an active RN license, 2 years of full-time practice as an
RN, 2,000 hours of case management clinical practice within the last 3 years, and 30 hours of case management continuing
education within the last 3 years. Options A and B understate or overstate the requirements and misstate the licensure level,
and option C omits the required specialty practice hours. Knowing eligibility standards is a certification competency
expected of CMGT-BC candidates and mentors.
Q8. A case manager using a strengths-based model is developing a plan with a 29-year-old client recovering from
opioid use disorder who feels defined by past relapses. Which case manager action best reflects this model?
A. Creating a relapse-prevention contract that lists the consequences of future nonadherence.
B. Building the plan around the client's employment history, family support, and demonstrated engagement in
treatment, and using those assets to pursue recovery goals. [CORRECT]
C. Recommending that the client repeat a completed program to reinforce the deficits identified at intake.
D. Assigning the highest acuity level to ensure the client receives the maximum available supervision.
Correct Answer: B
Rationale: The strengths-based model identifies and mobilizes the client's capabilities, resources, and past successes as the
foundation of the care plan, which builds self-efficacy and sustained engagement. Deficit-focused or punitive approaches
can reinforce stigma, reduce motivation, and contradict person-centered, recovery-oriented practice. Strengths-based
planning remains fully compatible with safety monitoring and clinically appropriate treatment.
CMGT-BC Verified Questions and Correct Answers 3
, Nursing Case Management Certification (CMGT-BC) Exam Preparation 2026/2027 Edition
Q9. A primary care practice reorganized its delivery system so that each patient is served by a designated personal
clinician and a supported team, with enhanced access, coordinated referrals, and population-level tracking of care
gaps. Which model of care does this describe?
A. The Chronic Care Model
B. Community-based case management
C. The patient-centered medical home [CORRECT]
D. The acute care case management model
Correct Answer: C
Rationale: The patient-centered medical home is a primary care delivery model organized around a personal clinician,
team-based comprehensive care, coordinated and integrated services, enhanced access, and quality and safety improvement,
including population management. The Chronic Care Model is a broader framework for improving chronic illness care
rather than a specific primary care reorganization. Community-based and acute care models describe settings or service
intensity, not this primary care structure.
Q10. A hospital case manager is planning the discharge of a 6-year-old with a new tracheostomy whose single parent
will provide home care. Which action best demonstrates the family-centered care model?
A. Involving the parent as a partner in every planning step, assessing family capabilities and stressors, and
tailoring teaching, respite, and equipment support to the family's needs. [CORRECT]
B. Directing the parent to follow the written instructions without discussion because the plan is based on expert
clinical judgment.
C. Limiting communication to brief daily updates to protect the team's efficiency.
D. Referring the child to foster services because the care needs exceed typical parenting skills.
Correct Answer: A
Rationale: Family-centered care recognizes the family as the constant in the child's life and as a care partner, requiring
collaboration, assessment of family strengths and burdens, and support such as education, respite, and equipment planning.
Directive or minimal communication disempowers caregivers and increases transition failure risk. Foster referral is neither
clinically indicated nor family-centered and reflects a failure to support caregiver capability.
Q11. A case manager employed by a health plan notices that productivity metrics reward limiting referrals to
high-cost community services. A client's assessment clearly indicates these services are needed. Which action aligns
best with professional case management standards?
A. Reducing referrals until the metric improves, since employment requires meeting productivity expectations.
B. Documenting the need but approving fewer services to balance the plan's financial position.
C. Transferring the client to another department so the decision is no longer the case manager's responsibility.
D. Advocating for the services the client's assessment supports, documenting the clinical rationale, and
escalating concerns about incentive structures through appropriate channels. [CORRECT]
Correct Answer: D
Rationale: Professional standards require the case manager to base decisions on assessment findings and client need, to
advocate for appropriate services, and to use formal channels to raise concerns about conflicts of interest. Suppressing
referrals to meet a metric violates the CCMC Code of Professional Conduct and quality expectations. Transferring the
decision away does not resolve the ethical duty, and partial approval without clinical justification is arbitrary.
CMGT-BC Verified Questions and Correct Answers 4
Verified Questions & Correct Answers – A+ Graded – 2026/2027 Edition
150 Questions | 8 ANCC CMGT-BC Aligned Domains | Scenario-Based Items with Verified Rationales | Answer Key Included
SECTION 1 Case Management Foundations and Standards
Scope of Practice, Core Competencies, Models of Care, and Ethical Standards | Questions 1-20
Q1. Which of the following statements most accurately reflects the definition of case management as articulated by
the Commission for Case Manager Certification (CCMC)?
A. A collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for
options and services to meet an individual's comprehensive health needs through communication and available
resources. [CORRECT]
B. A payer-driven utilization review process that authorizes only medically necessary services while minimizing
plan expenditures.
C. A disease management protocol that standardizes care for specific diagnoses using evidence-based clinical
pathways.
D. A discharge documentation process completed at the end of an inpatient admission to arrange post-acute
services.
Correct Answer: A
Rationale: The CCMC definition centers case management as a collaborative, client-focused process spanning assessment,
planning, facilitation, care coordination, evaluation, and advocacy across the continuum. Options B and C describe narrower
functions such as utilization review and disease management, which are components or related disciplines but not the full
definition. Option D reduces case management to episodic discharge paperwork, ignoring its longitudinal, cross-setting
scope that the CMGT-BC role is expected to lead.
Q2. According to the CCMC Code of Professional Conduct, when the interests of the case manager's employer
conflict with the safety and welfare of the client, the case manager's primary professional obligation is to:
A. Follow the employer's cost-containment policies, because employment agreements take precedence over
individual client concerns.
B. Hold the client's safety, welfare, and best interests as the first priority while acting within the code's
provisions and applicable regulations. [CORRECT]
C. Defer to the ordering physician, because clinical decision-making authority rests solely with the medical
staff.
D. Approve half of the disputed services to balance financial and clinical concerns.
Correct Answer: B
Rationale: The CCMC Code of Professional Conduct directs case managers to advance quality client outcomes and to place
client safety and welfare above personal or financial interests, even within a payer or employer setting. Employer policies
are followed only to the extent that they do not compromise the client's best interests or violate the code. Automatically
deferring to physicians abdicates the advocacy duty, and arbitrarily splitting services is neither standards-based nor
defensible.
CMGT-BC Verified Questions and Correct Answers 1
,Nursing Case Management Certification (CMGT-BC) Exam Preparation 2026/2027 Edition
Q3. A newly hired case manager is building a professional development plan and wants the document that defines the
practice expectations, competencies, and processes for professional case management across all practice settings.
Which resource best meets this need?
A. The Medicare Conditions of Participation for discharge planning.
B. The ANCC test content outline for the CMGT-BC examination.
C. The Case Management Society of America's Standards of Practice for Case Management. [CORRECT]
D. The facility's internal utilization management policy manual.
Correct Answer: C
Rationale: The CMSA Standards of Practice for Case Management articulate the scope, competencies, and practice
expectations for case managers across settings and are widely used to structure professional development and quality review.
The Medicare Conditions of Participation are regulatory requirements for institutional discharge planning rather than a
broad practice framework. The ANCC test outline describes examination content only, and internal policy manuals are
facility-specific rather than professional standards.
Q4. In an integrated hospital case management department, a staff nurse asks how the case manager role differs from
the concurrent utilization review nurse role. The case manager's most accurate response is that case management is
distinguished by:
A. Authorizing admissions while the utilization review nurse coordinates discharge services.
B. Working only with managed care contracts, while the utilization review nurse works within the hospital.
C. Assigning nursing diagnoses, while the utilization review nurse assigns medical diagnoses.
D. Longitudinal coordination across the continuum, including advocacy, transition planning, and linking the
client to resources, rather than episodic review of a single admission. [CORRECT]
Correct Answer: D
Rationale: Case management is a longitudinal, cross-continuum process that integrates assessment, care planning,
advocacy, transitions, and resource linkage for the client over time. Concurrent utilization review is an important supporting
function focused on medical necessity and level of care during a specific episode. The other options misstate the roles or
incorrectly separate coordination from the core case management function.
Q5. Which step comes first in the case management process as described by the Commission for Case Manager
Certification?
A. Assessing
B. Stratifying risk
C. Screening [CORRECT]
D. Planning
Correct Answer: C
Rationale: The CCMC case management process begins with screening to identify individuals who may benefit from case
management services, using referral data, utilization reports, and risk flags. Assessment, risk stratification, and planning
follow once a candidate has been identified and engaged. Sequencing matters because unsafe or inefficient plans result when
planning precedes assessment, and assessment cannot occur before candidates are identified.
CMGT-BC Verified Questions and Correct Answers 2
,Nursing Case Management Certification (CMGT-BC) Exam Preparation 2026/2027 Edition
Q6. A case manager receives referrals for four clients. Which client is most appropriate for assignment to intensive,
high-touch case management based on risk stratification principles?
A. A 67-year-old with heart failure, chronic kidney disease, depression, three hospitalizations in 6 months, and
unstable housing. [CORRECT]
B. A 34-year-old with well-controlled asthma who completed an annual wellness visit.
C. A 51-year-old with newly diagnosed hypertension prescribed a first-line agent who requires routine
monitoring.
D. A 45-year-old who calls the clinic monthly to request prescription refills on time.
Correct Answer: A
Rationale: Risk stratification uses clinical complexity, psychosocial barriers, prior utilization, and self-management
capacity to direct resources toward clients with the greatest need. This client combines multiple chronic conditions, a
behavioral health comorbidity, high prior utilization, and a social determinant barrier of unstable housing, all markers for
intensive case management. The other clients have stable, low-complexity profiles better served by population health
programs, standard monitoring, or brief interventions.
Q7. A medical-surgical registered nurse is interested in pursuing the ANCC Nursing Case Management board
certification (CMGT-BC). Which set of eligibility requirements must the nurse satisfy?
A. An active LPN or RN license, 1 year of nursing practice, and 500 case management hours within 2 years.
B. A master's degree in nursing, 3 years of RN practice, and 5,000 case management hours.
C. An active RN license and current employment as a case manager, with no minimum case management
practice hours.
D. An active RN license, 2 years of full-time practice as an RN, a minimum of 2,000 hours of clinical practice
in nursing case management within the last 3 years, and 30 continuing education hours in nursing case
management within the last 3 years. [CORRECT]
Correct Answer: D
Rationale: ANCC eligibility for the CMGT-BC credential requires an active RN license, 2 years of full-time practice as an
RN, 2,000 hours of case management clinical practice within the last 3 years, and 30 hours of case management continuing
education within the last 3 years. Options A and B understate or overstate the requirements and misstate the licensure level,
and option C omits the required specialty practice hours. Knowing eligibility standards is a certification competency
expected of CMGT-BC candidates and mentors.
Q8. A case manager using a strengths-based model is developing a plan with a 29-year-old client recovering from
opioid use disorder who feels defined by past relapses. Which case manager action best reflects this model?
A. Creating a relapse-prevention contract that lists the consequences of future nonadherence.
B. Building the plan around the client's employment history, family support, and demonstrated engagement in
treatment, and using those assets to pursue recovery goals. [CORRECT]
C. Recommending that the client repeat a completed program to reinforce the deficits identified at intake.
D. Assigning the highest acuity level to ensure the client receives the maximum available supervision.
Correct Answer: B
Rationale: The strengths-based model identifies and mobilizes the client's capabilities, resources, and past successes as the
foundation of the care plan, which builds self-efficacy and sustained engagement. Deficit-focused or punitive approaches
can reinforce stigma, reduce motivation, and contradict person-centered, recovery-oriented practice. Strengths-based
planning remains fully compatible with safety monitoring and clinically appropriate treatment.
CMGT-BC Verified Questions and Correct Answers 3
, Nursing Case Management Certification (CMGT-BC) Exam Preparation 2026/2027 Edition
Q9. A primary care practice reorganized its delivery system so that each patient is served by a designated personal
clinician and a supported team, with enhanced access, coordinated referrals, and population-level tracking of care
gaps. Which model of care does this describe?
A. The Chronic Care Model
B. Community-based case management
C. The patient-centered medical home [CORRECT]
D. The acute care case management model
Correct Answer: C
Rationale: The patient-centered medical home is a primary care delivery model organized around a personal clinician,
team-based comprehensive care, coordinated and integrated services, enhanced access, and quality and safety improvement,
including population management. The Chronic Care Model is a broader framework for improving chronic illness care
rather than a specific primary care reorganization. Community-based and acute care models describe settings or service
intensity, not this primary care structure.
Q10. A hospital case manager is planning the discharge of a 6-year-old with a new tracheostomy whose single parent
will provide home care. Which action best demonstrates the family-centered care model?
A. Involving the parent as a partner in every planning step, assessing family capabilities and stressors, and
tailoring teaching, respite, and equipment support to the family's needs. [CORRECT]
B. Directing the parent to follow the written instructions without discussion because the plan is based on expert
clinical judgment.
C. Limiting communication to brief daily updates to protect the team's efficiency.
D. Referring the child to foster services because the care needs exceed typical parenting skills.
Correct Answer: A
Rationale: Family-centered care recognizes the family as the constant in the child's life and as a care partner, requiring
collaboration, assessment of family strengths and burdens, and support such as education, respite, and equipment planning.
Directive or minimal communication disempowers caregivers and increases transition failure risk. Foster referral is neither
clinically indicated nor family-centered and reflects a failure to support caregiver capability.
Q11. A case manager employed by a health plan notices that productivity metrics reward limiting referrals to
high-cost community services. A client's assessment clearly indicates these services are needed. Which action aligns
best with professional case management standards?
A. Reducing referrals until the metric improves, since employment requires meeting productivity expectations.
B. Documenting the need but approving fewer services to balance the plan's financial position.
C. Transferring the client to another department so the decision is no longer the case manager's responsibility.
D. Advocating for the services the client's assessment supports, documenting the clinical rationale, and
escalating concerns about incentive structures through appropriate channels. [CORRECT]
Correct Answer: D
Rationale: Professional standards require the case manager to base decisions on assessment findings and client need, to
advocate for appropriate services, and to use formal channels to raise concerns about conflicts of interest. Suppressing
referrals to meet a metric violates the CCMC Code of Professional Conduct and quality expectations. Transferring the
decision away does not resolve the ethical duty, and partial approval without clinical justification is arbitrary.
CMGT-BC Verified Questions and Correct Answers 4
