Certified Nursing Case Management

Health Status Survey predictive modeling Role function activity process Likert Scale Caseload Matrix Standards of Practice A tool that provides a clients self assess- ment and functional health and quality of life issues A process in which historical data based on behaviors and events are blended with multiple variables and used to con- struct models of anticipated future out- comes. a set of expectations (norms) about a social position, defining how those in the position ought to behave Set of tasks that are completed as part of a role Specific task to meet the needs of the role A series of actions or steps taken to achieve an end/goal a numerical scale used to assess atti￾tudes; includes a set of possible answers with labeled anchors on each extreme. 1- able to do 2- moderate 3- severe 4- needs total asst Identifies variables in various settings af￾fecting caseload. 1- initial elements 2- comprehensive needs assessment 3- case management interventions 4- outcomes A list of standards to assist the profes- sional in making good decisions while conducting day to day responsibilities within his or her scope of practice. Certified Case Management 2 / 18 standards of care evidence-based practice Rancho Los Amigos Scale social security disability insurance COBRA patient activation measure (PAM) WHODAS (World Health Organization Disability Assessment Schedule) Utilization Management (UM) legal requirements for nursing practice that describe minimum acceptable nurs￾ing care nursing care provided that is supported by sound scientific rationale evaluates traumatic brain injuries I-nonresponsive; II, III- decreased re- sponse; IV, V, VI- confused; VII-VIII-ap- propriate levels Pays benefits to the individual (and cer￾tain family members) if the individual worked long enough and paid Social Se- curity taxes. Consolidated Omnibus Budget Recon- ciliation Act; law to provide terminated employees or those who lose insurance coverage because of reduced work to be able to buy group insurance for them- selves and their families for a limited amount of time. if disabled within 60 days of obtaining Co- bra and remain disabled throughout 18 months of coverage then you will be able to apply for an additional 11 month ex￾tension for a total coverage of 29 months 13 item predictive screening tool to eval- uate a client's ability for self care. - higher the score the better (scored 0-52) -predicts health care outcomes, medica￾tion adherence and ER visits. Assesses general health and disabili￾ty including mental, neuro, substance abuse. Collection of systems and processes used to determine if health care ser- Certified Case Management 3 / 18 Utilization review Medicare Medicare Part B Medicare Part A (Hospital Insurance) Medicare—Part D Prescription Drug Coverage Medicaid SCHIP (State Children's Health Insur- ance Program) WHCRA ( Women's health and cancer right act) TEFRA vices are appropriate and medically nec- essary. process of evaluating the appropriate- ness of services provided A federal program of health insurance for persons 65 years of age and older The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equip- ment, and other services and supplies. covers Medicare inpatient care, including care received while in a hospital, a skilled nursing facility, and, in limited cir- cumstances, at home. is a voluntary program for paying for your prescription drugs. If you earn more, you pay more. A federal and state assistance program that pays for health care services for peo- ple who cannot afford them. Can be 3 months retroactive. is a program administered by the United States Department of Health and Human Services that provides matching funds to states for health insurance to families with children. Requires insurance coverage of breast construction or complications of mastectomy if plan provides medical/surgical benefits for mastectomy Tax Equity and Fiscal Responsibility Act provides incentives for cost contamination System that categorizes into payment groups patients who are medically relat-