Exam #1: Case Management Study Guide Exam Questions and Answers

Exam #1: Case Management Study Guide Exam Questions and Answers


1. What is a case manager accountable for?: The case manager is accountable for collabora
e e e e e e e e e e e e e



tively facilitating the assessment, planning, implementation and evalu-
e e e e e e e



eation of care coordination and care transitions in the acute care setting.
e e e e e e e e e e e



2. What are case managers advocates for?: Nurse case managers serve as advocates f
e e e e e e e e e e e e



or options and services to meet the patient and family needs, while promoting quality, co
e e e e e e e e e e e e e e



st effective outcomes for the assigned case types.
e e e e e e e



3. What are 5 key functions and responsibilities of a case manager?: 1. Coor-
e e e e e e e e e e e e



edination and facilitation of care e e e e



2. Utilization and resource management e e e



3. Tracking of avoidable delays e e e



4. Transitional and discharge planning e e e



5. Quality and process improvement e e e



4. A nurse case manager must encompass a knowledge of the health care environmen
e e e e e e e e e e e e



t with regards to what 4 aspects?: 1. Clinical
e e e e e e e e



2. Business/Financial
3. Managerial
4. Professionalism
5. In the clinical setting, what type of assessment does the case manager perform?: P
e e e e e e e e e e e e e



atient and family interview and review of medical record
e e e e e e e e



6. What type of planning is performed by the case manager in a clinical setting?: Consult w
e e e e e e e e e e e e e e e



ith the physician, health care team and patient/family -
e e e e e e e e



edevelop plan of care to facilitate a timely discharge /transition plan
e e e e e e e e e e



7. What type of implementation is performed by the case manager in the clinical set
e e e e e e e e e e e e e



ting?: Implements the plan of care in a timely manner to facilitate accomplishment of g
e e e e e e e e e e e e e e



oals and interventions.
e e



8. What type of evaluations do case managers perform in the clinical setting?-
e e e e e e e e e e e



: Reassessment for any decline in status and plan revisions
e e e e e e e e e



9. What are 4 roles of the case manager in managing business/financial con-
e e e e e e e e e e e




1e/e
16

,cerns?: 1. Ensure that the level of care is appropriate and services are medically necessary
e e e e e e e e e e e e e e e



2. Proactively identify delays in care, delays in discharge and risk of readmission
e e e e e e e e e e e



3. Maintain competence of utilization review (inpatient vs. observation status)
e e e e e e e e



4. Document avoidable delays/days e e



10. What are 5 managerial duties of the case manager?: 1. A nurse case man-
e e e e e e e e e e e e e



ager must display leadership skills in decision making and problem solving
e e e e e e e e e e e



2. Must actively participate in Interdisciplinary Team Meetings and maintain open communi
e e e e e e e e e e



cation with physicians
e e



3. Strive to make productive use of time through the setting of priorities
e e e e e e e e e e e



4. Foster an environment of professionalism
e e e e




2e/e
16

, 5. Utilize the Chain of Command effectively in addressing complex/unusual situa- tions
e e e e e e e e e e



11. What are 5 key points that the case manager is responsible for in instituting professionali
e e e e e e e e e e e e e e



sm in the profession?: 1. Integrate high ethical standards and core values
e e e e e e e e e e e



2. Hold self and others accountablee e e e



3. Perform work in an accurate and timely manner e e e e e e e



4. Serve as a role model and mentor e e e e e e



5. Maintain current clinical knowledge and leadership skills e e e e e e



12. What is a clinical pathway?: A clinical pathway is a map of clinical practice for a particular
e e e e e e e e e e e e e e e e



diagnosis -
e e



also known as care maps. It is a timeline for patient care activities which is used by all discipli
e e e e e e e e e e e e e e e e e e e



nes
13. What are clinical pathways used to achieve?: Clinical pathways have emerged as a pop
e e e e e e e e e e e e e



ular method to standardize care while reducing costs and improv- ing quality of care
e e e e e e e e e e e e e



14. What term has Cone Health renamed their clinical pathways and why?: -
e e e e e e e e e e e



Cone Health has renamed them to "Patient Care Plan" in an attempt to make them more indivi
e e e e e e e e e e e e e e e e e



dualized
15. What are 3 advantages of clinical pathways?: 1. Enhances interdisciplinary collaborati
e e e e e e e e e e



on
2. Helps to reduce unnecessary variations in patient care and outcomes, improving quality
e e e e e e e e e e e



3. A tool to incorporate local and national guidelines into everyday practices
e e e e e e e e e e



16. How are clinical pathways used? (3): 1. Permanent part of medical record
e e e e e e e e e e e



2. Used in lieu of Care Plan and Orderse e e e e e e



3. The nurse in charge and the attending physician will select the appropriate on admission
e e e e e e e e e e e e e



17. How are clinical pathways used in the case management process? (2): 1. Clinical path
e e e e e e e e e e e e e



ways help case managers appropriately manage a patient's care related to the admitting diagno
e e e e e e e e e e e e e



sis
2.CP help to improve quality, decrease cost, manage length of stay and avoid delays in care
e e e e e e e e e e e e e e e e



18. In what settings are we now finding case management now that it has moved past
e e e e e e e e e e e e e e e



the acute care setting? (5): 1. Home health agencies
e e e e e e e e



2. Physician practices e



3. Medical respite programs e e



3e/e
16