CASE MANAGEMENT CERTIFICATION
ACTUAL TEST PAPER FULL QUESTIONS
AND ACCURATE ANSWERS GRADED
APLUS
●● The Case Management Process consists of:
Answer: Screening, Stratifying Risk, Assessing, Planning, Implementing
(Care Coordination), Following-up, Transitioning (transitional care),
Communication post-transition, evaluation. (Can take place concurrently
or be revisited).
●● Clients may be appropriate for case managed based on:
Answer: Diagnosis, high dollar diagnosis, high utilization, poor pain
control, chronic, catastrophic illness, social issues (weak or non-existent
support system), difficult discharge planning, financial issues.
●● What do case managers use to classify clients into low, moderate, or
high-risk categories?
Answer: Biometric screening & health risk assessment tools
●● Assessment Phase
Answer: Similar to screening but provides a more in-depth look at the
client's healthcare situation. Includes medical history, current medical
conditions, function and cognitive status, health insurance status,
,spiritual life, psychosocial concerns, environment,
vocational/educational status, financial status, support system, culture
and language, self-care capability, health literacy, health goals, readiness
to change, past and current service utilization, current medications,
safety.
●● Interventions
Answer: Treatments, resources and services needed to meet the client's
needs and goals and should apply evidence-based standards and care
guidelines.
●● SMART Goal
Answer: Specific
Measurable
Achievable
Realistic
Time-bound
●● Implementation Phase
Answer: Case management plan is carried out aka care coordination
●● Planning Phase
Answer: The interventions arranged in the planning phase are executed,
coordinated and secured.
,●● Transitions of Care
Answer: Can happen across the health and human services continuum, to
differing levels of care, to another case manager, or from the case
management program, and often put the client at increased risk for
adverse events.
●● Evaluation Phase
Answer: May focus on:
Financial evaluation: Cost-benefit analysis and return on investment
Clinical outcomes
Quality of Life
Client Satisfation
Self-care management ability
Knowledge of health conditions and plan of care
●● If a conflict arises between client, provider and payer, with whom
does the priority lie?
Answer: The client/patient
●● If a CM works in a physician office, ambulatory care clinic,
accountable care organization, corporation, and community-based
organization (healthcare center or university clinic), their role will likely
be geared towards what?
, Answer: Prevention
●● Case Management Models (3)
Answer: 1. Patient flow: making sure the patient moves through the
acute care setting in a timely manner.
2. Utilization Management (UM): communicating with payer sources.
3. Discharge planning (DCP): moving the patient to the next level of
care.
1. Integrated CM Model: CM performs all roles - SW may be consulted
if appropriate.
2. Dyad Model: RN and SW CMs work together in one department.
3. Triad Model / Collaborative Case Management: Third person is
involved who takes over UM activities.
●● If a CM works in palliative care or hospice care, their role will likely
be geared towards what?
Answer: Hands-on care and caregiver role.
●● CM role in workers' compensation cases
Answer: Focuses on vocational activities, such as collaborating with the
employer to get the employee back to work.
●● Life care planning
ACTUAL TEST PAPER FULL QUESTIONS
AND ACCURATE ANSWERS GRADED
APLUS
●● The Case Management Process consists of:
Answer: Screening, Stratifying Risk, Assessing, Planning, Implementing
(Care Coordination), Following-up, Transitioning (transitional care),
Communication post-transition, evaluation. (Can take place concurrently
or be revisited).
●● Clients may be appropriate for case managed based on:
Answer: Diagnosis, high dollar diagnosis, high utilization, poor pain
control, chronic, catastrophic illness, social issues (weak or non-existent
support system), difficult discharge planning, financial issues.
●● What do case managers use to classify clients into low, moderate, or
high-risk categories?
Answer: Biometric screening & health risk assessment tools
●● Assessment Phase
Answer: Similar to screening but provides a more in-depth look at the
client's healthcare situation. Includes medical history, current medical
conditions, function and cognitive status, health insurance status,
,spiritual life, psychosocial concerns, environment,
vocational/educational status, financial status, support system, culture
and language, self-care capability, health literacy, health goals, readiness
to change, past and current service utilization, current medications,
safety.
●● Interventions
Answer: Treatments, resources and services needed to meet the client's
needs and goals and should apply evidence-based standards and care
guidelines.
●● SMART Goal
Answer: Specific
Measurable
Achievable
Realistic
Time-bound
●● Implementation Phase
Answer: Case management plan is carried out aka care coordination
●● Planning Phase
Answer: The interventions arranged in the planning phase are executed,
coordinated and secured.
,●● Transitions of Care
Answer: Can happen across the health and human services continuum, to
differing levels of care, to another case manager, or from the case
management program, and often put the client at increased risk for
adverse events.
●● Evaluation Phase
Answer: May focus on:
Financial evaluation: Cost-benefit analysis and return on investment
Clinical outcomes
Quality of Life
Client Satisfation
Self-care management ability
Knowledge of health conditions and plan of care
●● If a conflict arises between client, provider and payer, with whom
does the priority lie?
Answer: The client/patient
●● If a CM works in a physician office, ambulatory care clinic,
accountable care organization, corporation, and community-based
organization (healthcare center or university clinic), their role will likely
be geared towards what?
, Answer: Prevention
●● Case Management Models (3)
Answer: 1. Patient flow: making sure the patient moves through the
acute care setting in a timely manner.
2. Utilization Management (UM): communicating with payer sources.
3. Discharge planning (DCP): moving the patient to the next level of
care.
1. Integrated CM Model: CM performs all roles - SW may be consulted
if appropriate.
2. Dyad Model: RN and SW CMs work together in one department.
3. Triad Model / Collaborative Case Management: Third person is
involved who takes over UM activities.
●● If a CM works in palliative care or hospice care, their role will likely
be geared towards what?
Answer: Hands-on care and caregiver role.
●● CM role in workers' compensation cases
Answer: Focuses on vocational activities, such as collaborating with the
employer to get the employee back to work.
●● Life care planning
