Certified Case Manager Questions with Complete Solutions

Certified Case Manager Questions with Complete Solutions Principles of Case Management Practice - CORRECT ANSWER 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 - CORRECT ANSWER diagnosis, high utilizers, age & health status, procedure, LOS, psychological factors, vocational, functional impairments, disability Case finding and intake - CORRECT ANSWER ID member, obtain consent, communicating member needs to others, ID members who need alternate levels of care Provision of services - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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