Certified Case Manager Test Prep Questions and Answers

Principles of Case Management Practice focus on pt and family, negotiating, procuring and coordinating services and resources, use of clinical reasoning, development of various relationships, episode or continuum based Target Populations diagnosis, high utilizers, age & health status, procedure, LOS, psychological factors, vocational, functional impairments, disability Case finding and intake ID member, obtain consent, communicating member needs to others, ID members who need alternate levels of care Provision of services facilitate and coordinate, communicate with other healthcare providers, monitor progress, review and modify healthcare services, collaborate with stakeholders on CM plan, advocate for pt and family, assure adherence to various standards Evaluation and Case closure collect, analyze and report data, evaluate quality of services, ensure access to services, apply evidence based practices, close relationship when appropriate, report termination to stakeholders, education pt re illness prevention Utilization Management evaluate appropriate level of care, communicate with payers and healthcare providers, allocate resources, manage appeals and denials, review pt condition for appropriateness of hospitalization, ID cases that are at risk for complications Psychosocial & economic issues review pt social & financial resources, assess support network, consider culture, evaluate ability of caregiver outside hospital setting, determine eligibility for insurance coverage or charity services Vocational issues ID need for changes in home environment, eliminate access barriers, determine need for specialized services, arrange vocational assessment and services, coordinate job analysis to implement modifications, manage return to work activities Clinical Patient Care Role Discuss preventive services, direct patient care, asses coping skills, social supports, financial/insurance status, intervene when problems ID'd, facilitate progress through healthcare system, arrange for consultations with specialists, ensure transfer to appropriate levels of care, collaborate with team