CASE MANAGER CORRECT EXAMS ANSWERS AND
QUESTIONS SET A+
✔✔patient centered medical home (PCMH) - ✔✔a care delivery model whereby patient
treatment is coordinated through their primary care physician to ensure they receive the
necessary care when and where they need it, in a manner they can understand.
✔✔national quality forum - ✔✔not for profit membership organization to develop and
implement a national strategy for standardizing health care quality measures and
reporting. This organization was charged by the affordable care act to create the
national priorities partnership and nursing sensitive care standards ( death of surgery
patients, pressure ulcers, falls, restraints, UTIs urinary catheters), ventilator associated
pneumonia, smoking cessation)
✔✔national committee for quality assurance (NCQA) - ✔✔private not for profit
organization that accredits certain organizations if they meet standards to improve
health care quality. includes a quality compass to score health plans.
✔✔utilization review accreditation commission (URAC) - ✔✔An independent nonprofit
organization that offers quality benchmark programs to improve quality and
accountability of health care organizations.
✔✔Joint Commission - ✔✔not for profit organization that set performance standards
and accredit hospitals, nursing homes, and ambulatory care clinics for safe and
effective care with site visits every 3 years. Quality Seal.
✔✔Magnet - ✔✔accreditation developed by ANCC demonstrating quality nursing
leadership and excellence. It focuses on: Quality, identifying excellence in nursing, and
disseminating best practice.
✔✔International Organization for Standardization (ISO) - ✔✔not for profit organizations
that identifies and develops standards for everything.
,✔✔Peer Review Quality Improvement Organization (QIO) - ✔✔private not for profit
organization contracted by the center for medicare and medicaid services consisting of
health care professionals who review complaints about care and implement changes for
medicare patients. They ensure the patient right care for the right person at the right
time is safe, patient centered, timely, and equitable. Part of the US department of health
and human services.
✔✔quality management - ✔✔prevention of client care problems
✔✔risk management - ✔✔analyzes problems and minimizes losses after an error
occurs. evaluates options, cost, feasibility, social and selects and implements measures
to decrease risk
✔✔risk assessment - ✔✔evaluates hazards, cost, feasibility, dose-response model.
✔✔risk communication - ✔✔an important step in risk management that involves
stakeholders from the start
✔✔aggregate data - ✔✔data that has a common variable. An example would be
diabetes.
✔✔root cause analysis - ✔✔process of identifying the cause and factors contributing to
variation in performance outcomes.
✔✔histogram - ✔✔bar graph used to display numerical data. It can show a trend such
as a bell shaped.
✔✔return on investiment - ✔✔the measure of a company's ability to use a profit and
then generate addition value for patients and providers
✔✔benchmarking - ✔✔ongoing system of measuring things against another. Helpful for
providers to increase competitors.
✔✔predictive modeling - ✔✔a way of using data to predict what will occur in the future
for health care or behavior. it confirms correlation between patients with specific
diagnosis and improved outcomes as a result of target outreach. Used in disease
management.
✔✔pay for performance - ✔✔method of payment used by medicare
✔✔resource management - ✔✔process of identifying, confirming, coordinating,
negotiating resources
✔✔utilization management - ✔✔forward looking evaluation
, ✔✔utilization review - ✔✔backward looking evaluation
✔✔quality management - ✔✔looks at prevention of patient problems
✔✔risk management - ✔✔analyses a problem and reduces losses after an error
✔✔disease management - ✔✔population specific aggregate data that encourages self
care, triage, improved quality and decreased cost.
✔✔regulations - ✔✔interpretations of law that constitutes or constraints rights and
allocates responsibility
✔✔standards of practice or care - ✔✔guidelines of what an RN should or should not
due. a benchmark of excellence.
✔✔scope of practice - ✔✔actions permitted by law
✔✔code of ethics - ✔✔succinct statements of ethical obligations and duties, goals, and
values.
✔✔scope of nursing practice - ✔✔describes nursing practice dependent on education,
experience, role and population
✔✔standards of professional nursing practice - ✔✔authoritative statements of RN duties
everyone is expected to fill regardless of role, population or specialty.
✔✔Health insurance portability and accountability act (HIPAA) - ✔✔This does not apply
in treatment, billing, required reporting, quality assurance, peer review, business
planning, training, emergencies
✔✔privacy practices - ✔✔HIPAA individual right #1 is the right of the individual to
receive information on the health care provider's what?
✔✔request restrictions - ✔✔HIPAA individual right #2 is the right of the individual to
what? access to health information
✔✔access, inspect, copy - ✔✔HIPAA individual right #3 is the individual's right to their
health information to do what?
✔✔disclosures - ✔✔HIPAA individual right #4 is the right to request an accounting of all
health information what?
QUESTIONS SET A+
✔✔patient centered medical home (PCMH) - ✔✔a care delivery model whereby patient
treatment is coordinated through their primary care physician to ensure they receive the
necessary care when and where they need it, in a manner they can understand.
✔✔national quality forum - ✔✔not for profit membership organization to develop and
implement a national strategy for standardizing health care quality measures and
reporting. This organization was charged by the affordable care act to create the
national priorities partnership and nursing sensitive care standards ( death of surgery
patients, pressure ulcers, falls, restraints, UTIs urinary catheters), ventilator associated
pneumonia, smoking cessation)
✔✔national committee for quality assurance (NCQA) - ✔✔private not for profit
organization that accredits certain organizations if they meet standards to improve
health care quality. includes a quality compass to score health plans.
✔✔utilization review accreditation commission (URAC) - ✔✔An independent nonprofit
organization that offers quality benchmark programs to improve quality and
accountability of health care organizations.
✔✔Joint Commission - ✔✔not for profit organization that set performance standards
and accredit hospitals, nursing homes, and ambulatory care clinics for safe and
effective care with site visits every 3 years. Quality Seal.
✔✔Magnet - ✔✔accreditation developed by ANCC demonstrating quality nursing
leadership and excellence. It focuses on: Quality, identifying excellence in nursing, and
disseminating best practice.
✔✔International Organization for Standardization (ISO) - ✔✔not for profit organizations
that identifies and develops standards for everything.
,✔✔Peer Review Quality Improvement Organization (QIO) - ✔✔private not for profit
organization contracted by the center for medicare and medicaid services consisting of
health care professionals who review complaints about care and implement changes for
medicare patients. They ensure the patient right care for the right person at the right
time is safe, patient centered, timely, and equitable. Part of the US department of health
and human services.
✔✔quality management - ✔✔prevention of client care problems
✔✔risk management - ✔✔analyzes problems and minimizes losses after an error
occurs. evaluates options, cost, feasibility, social and selects and implements measures
to decrease risk
✔✔risk assessment - ✔✔evaluates hazards, cost, feasibility, dose-response model.
✔✔risk communication - ✔✔an important step in risk management that involves
stakeholders from the start
✔✔aggregate data - ✔✔data that has a common variable. An example would be
diabetes.
✔✔root cause analysis - ✔✔process of identifying the cause and factors contributing to
variation in performance outcomes.
✔✔histogram - ✔✔bar graph used to display numerical data. It can show a trend such
as a bell shaped.
✔✔return on investiment - ✔✔the measure of a company's ability to use a profit and
then generate addition value for patients and providers
✔✔benchmarking - ✔✔ongoing system of measuring things against another. Helpful for
providers to increase competitors.
✔✔predictive modeling - ✔✔a way of using data to predict what will occur in the future
for health care or behavior. it confirms correlation between patients with specific
diagnosis and improved outcomes as a result of target outreach. Used in disease
management.
✔✔pay for performance - ✔✔method of payment used by medicare
✔✔resource management - ✔✔process of identifying, confirming, coordinating,
negotiating resources
✔✔utilization management - ✔✔forward looking evaluation
, ✔✔utilization review - ✔✔backward looking evaluation
✔✔quality management - ✔✔looks at prevention of patient problems
✔✔risk management - ✔✔analyses a problem and reduces losses after an error
✔✔disease management - ✔✔population specific aggregate data that encourages self
care, triage, improved quality and decreased cost.
✔✔regulations - ✔✔interpretations of law that constitutes or constraints rights and
allocates responsibility
✔✔standards of practice or care - ✔✔guidelines of what an RN should or should not
due. a benchmark of excellence.
✔✔scope of practice - ✔✔actions permitted by law
✔✔code of ethics - ✔✔succinct statements of ethical obligations and duties, goals, and
values.
✔✔scope of nursing practice - ✔✔describes nursing practice dependent on education,
experience, role and population
✔✔standards of professional nursing practice - ✔✔authoritative statements of RN duties
everyone is expected to fill regardless of role, population or specialty.
✔✔Health insurance portability and accountability act (HIPAA) - ✔✔This does not apply
in treatment, billing, required reporting, quality assurance, peer review, business
planning, training, emergencies
✔✔privacy practices - ✔✔HIPAA individual right #1 is the right of the individual to
receive information on the health care provider's what?
✔✔request restrictions - ✔✔HIPAA individual right #2 is the right of the individual to
what? access to health information
✔✔access, inspect, copy - ✔✔HIPAA individual right #3 is the individual's right to their
health information to do what?
✔✔disclosures - ✔✔HIPAA individual right #4 is the right to request an accounting of all
health information what?
