CCM-P Certified Case Manager – Pediatric | A
CCM-P - CERTIFIED CASE MANAGER PEDIATRIC | 100%
VERIFIED LATEST EXAM QUESTIONS AND CORRECT
ANSWERS | 2026/2027
CERTIFIED CASE MANAGER - PEDIATRIC (CCM-P)
1. What is the primary goal of pediatric case management?
A. Replacing the role of the primary care pediatrician
B. Controlling the payer's annual budget for pediatric services
C. Shortening every hospital length of stay regardless of the child's
readiness
D. Coordinating services so the child reaches optimal health and function
within the context of the family, while using resources efficiently
Answer: D. Coordinating services so the child reaches optimal health
and function within the context of the family, while using resources
efficiently
Pediatric case management is child-focused and family-centered; cost-
efficiency matters, but it serves quality outcomes rather than replacing
them.
2. Which step of the case management process comes first?
A. Monitoring and follow-up
B. Screening and client selection
C. Developing the plan of care
D. Evaluation of outcomes
Answer: B. Screening and client selection
The CMSA process begins with identifying and screening clients who
would benefit from case management before assessment and planning
follow.
Page 1 of 67
, CCM-P Certified Case Manager – Pediatric | A
3. In pediatric case management, who is generally considered the unit
of care?
A. The attending physician and care team
B. The child together with the family or legal caregivers
C. The health plan that authorizes services
D. The child alone, separate from the household
Answer: B. The child together with the family or legal caregivers
Children depend on their caregivers for decisions and daily care, so
pediatric case management treats the child and family as one unit.
4. Which set of characteristics best describes the medical home as
defined by the American Academy of Pediatrics?
A. Insurance-directed, standardized, and limited to acute care
B. Located inside the child's home with daily nursing visits
C. Hospital-based, specialist-led, episodic, and cost-driven
D. Accessible, continuous, comprehensive, family-centered, coordinated,
compassionate, and culturally effective
Answer: D. Accessible, continuous, comprehensive, family-centered,
coordinated, compassionate, and culturally effective
The AAP describes the medical home as an approach to primary care with
these seven qualities, not a physical building.
5. The medical home concept was first introduced in 1967 by which
organization?
A. Centers for Medicare & Medicaid Services
B. World Health Organization
C. American Academy of Pediatrics
D. Case Management Society of America
Answer: C. American Academy of Pediatrics
The AAP first used the term in 1967 to describe a central source of a
child's medical records, later expanding it into a full model of care.
Page 2 of 67
, CCM-P Certified Case Manager – Pediatric | A
6. Which child is the strongest candidate for referral to case
management?
A. A healthy 2-year-old seen for a routine well-child visit
B. A 6-year-old with medical complexity who has had four readmissions
in the last six months
C. A 14-year-old treated once for a sprained ankle
D. A 10-year-old discharged after an uncomplicated appendectomy
Answer: B. A 6-year-old with medical complexity who has had four
readmissions in the last six months
Frequent readmissions combined with a complex chronic condition are
classic high-risk screening triggers for case management.
7. When acting as an advocate, the pediatric case manager primarily
works to
A. Ensure the facility meets its monthly discharge targets
B. Make treatment decisions on behalf of the family
C. Represent the payer during benefit negotiations
D. Promote the interests of the child and family and support their ability
to make informed choices
Answer: D. Promote the interests of the child and family and support
their ability to make informed choices
Advocacy centers on the client's interests and self-determination, even
when that requires challenging systems or payers.
8. According to the Maternal and Child Health Bureau (1998), children
with special health care needs are those who
A. Have been hospitalized at least once in the past year
B. Qualify for Supplemental Security Income
C. Have or are at increased risk for a chronic physical, developmental,
behavioral, or emotional condition and need services beyond those
required by children generally
D. Receive special education under an IEP
Answer: C. Have or are at increased risk for a chronic physical,
developmental, behavioral, or emotional condition and need services
beyond those required by children generally
The MCHB definition is broad and includes children at increased risk, not
only those with a diagnosed condition or a particular benefit.
Page 3 of 67
, CCM-P Certified Case Manager – Pediatric | A
9. A shared plan of care for a child with special health care needs is
best described as
A. A hospital discharge summary written by the attending physician
B. A payer authorization listing approved services
C. A school document limited to educational goals
D. A plan developed jointly by the family and providers that is accessible
to everyone involved in the child's care
Answer: D. A plan developed jointly by the family and providers that
is accessible to everyone involved in the child's care
A shared plan of care is co-created with the family and travels across
settings so all team members work toward the same goals.
10. Which factor is most important when determining an appropriate
caseload size for a pediatric case manager?
A. The geographic size of the health plan's region
B. The acuity and complexity of the children and families on the caseload
C. The number of physicians in the practice
D. The number of years the case manager has been certified
Answer: B. The acuity and complexity of the children and families on
the caseload
Highly complex families require far more time, so acuity rather than a
fixed number should drive caseload decisions.
SECTION 2: GROWTH AND DEVELOPMENT
11. According to Erikson, a child aged 18 months to 3 years is in which
psychosocial stage?
A. Trust versus mistrust
B. Autonomy versus shame and doubt
C. Initiative versus guilt
D. Industry versus inferiority
Answer: B. Autonomy versus shame and doubt
Toddlers work on independence; allowing simple choices during care
supports autonomy.
Page 4 of 67
CCM-P - CERTIFIED CASE MANAGER PEDIATRIC | 100%
VERIFIED LATEST EXAM QUESTIONS AND CORRECT
ANSWERS | 2026/2027
CERTIFIED CASE MANAGER - PEDIATRIC (CCM-P)
1. What is the primary goal of pediatric case management?
A. Replacing the role of the primary care pediatrician
B. Controlling the payer's annual budget for pediatric services
C. Shortening every hospital length of stay regardless of the child's
readiness
D. Coordinating services so the child reaches optimal health and function
within the context of the family, while using resources efficiently
Answer: D. Coordinating services so the child reaches optimal health
and function within the context of the family, while using resources
efficiently
Pediatric case management is child-focused and family-centered; cost-
efficiency matters, but it serves quality outcomes rather than replacing
them.
2. Which step of the case management process comes first?
A. Monitoring and follow-up
B. Screening and client selection
C. Developing the plan of care
D. Evaluation of outcomes
Answer: B. Screening and client selection
The CMSA process begins with identifying and screening clients who
would benefit from case management before assessment and planning
follow.
Page 1 of 67
, CCM-P Certified Case Manager – Pediatric | A
3. In pediatric case management, who is generally considered the unit
of care?
A. The attending physician and care team
B. The child together with the family or legal caregivers
C. The health plan that authorizes services
D. The child alone, separate from the household
Answer: B. The child together with the family or legal caregivers
Children depend on their caregivers for decisions and daily care, so
pediatric case management treats the child and family as one unit.
4. Which set of characteristics best describes the medical home as
defined by the American Academy of Pediatrics?
A. Insurance-directed, standardized, and limited to acute care
B. Located inside the child's home with daily nursing visits
C. Hospital-based, specialist-led, episodic, and cost-driven
D. Accessible, continuous, comprehensive, family-centered, coordinated,
compassionate, and culturally effective
Answer: D. Accessible, continuous, comprehensive, family-centered,
coordinated, compassionate, and culturally effective
The AAP describes the medical home as an approach to primary care with
these seven qualities, not a physical building.
5. The medical home concept was first introduced in 1967 by which
organization?
A. Centers for Medicare & Medicaid Services
B. World Health Organization
C. American Academy of Pediatrics
D. Case Management Society of America
Answer: C. American Academy of Pediatrics
The AAP first used the term in 1967 to describe a central source of a
child's medical records, later expanding it into a full model of care.
Page 2 of 67
, CCM-P Certified Case Manager – Pediatric | A
6. Which child is the strongest candidate for referral to case
management?
A. A healthy 2-year-old seen for a routine well-child visit
B. A 6-year-old with medical complexity who has had four readmissions
in the last six months
C. A 14-year-old treated once for a sprained ankle
D. A 10-year-old discharged after an uncomplicated appendectomy
Answer: B. A 6-year-old with medical complexity who has had four
readmissions in the last six months
Frequent readmissions combined with a complex chronic condition are
classic high-risk screening triggers for case management.
7. When acting as an advocate, the pediatric case manager primarily
works to
A. Ensure the facility meets its monthly discharge targets
B. Make treatment decisions on behalf of the family
C. Represent the payer during benefit negotiations
D. Promote the interests of the child and family and support their ability
to make informed choices
Answer: D. Promote the interests of the child and family and support
their ability to make informed choices
Advocacy centers on the client's interests and self-determination, even
when that requires challenging systems or payers.
8. According to the Maternal and Child Health Bureau (1998), children
with special health care needs are those who
A. Have been hospitalized at least once in the past year
B. Qualify for Supplemental Security Income
C. Have or are at increased risk for a chronic physical, developmental,
behavioral, or emotional condition and need services beyond those
required by children generally
D. Receive special education under an IEP
Answer: C. Have or are at increased risk for a chronic physical,
developmental, behavioral, or emotional condition and need services
beyond those required by children generally
The MCHB definition is broad and includes children at increased risk, not
only those with a diagnosed condition or a particular benefit.
Page 3 of 67
, CCM-P Certified Case Manager – Pediatric | A
9. A shared plan of care for a child with special health care needs is
best described as
A. A hospital discharge summary written by the attending physician
B. A payer authorization listing approved services
C. A school document limited to educational goals
D. A plan developed jointly by the family and providers that is accessible
to everyone involved in the child's care
Answer: D. A plan developed jointly by the family and providers that
is accessible to everyone involved in the child's care
A shared plan of care is co-created with the family and travels across
settings so all team members work toward the same goals.
10. Which factor is most important when determining an appropriate
caseload size for a pediatric case manager?
A. The geographic size of the health plan's region
B. The acuity and complexity of the children and families on the caseload
C. The number of physicians in the practice
D. The number of years the case manager has been certified
Answer: B. The acuity and complexity of the children and families on
the caseload
Highly complex families require far more time, so acuity rather than a
fixed number should drive caseload decisions.
SECTION 2: GROWTH AND DEVELOPMENT
11. According to Erikson, a child aged 18 months to 3 years is in which
psychosocial stage?
A. Trust versus mistrust
B. Autonomy versus shame and doubt
C. Initiative versus guilt
D. Industry versus inferiority
Answer: B. Autonomy versus shame and doubt
Toddlers work on independence; allowing simple choices during care
supports autonomy.
Page 4 of 67
