NURS440 EXAM 3 – Questions & Correct Answers
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Sherpath: Diabetes Mellitus Chapter 21 Test Case Study 4 (Short
30 terms 24 terms 22 terms
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Terms in this set (78)
What s a part of coordination of care for management and implementation
individual clients?
Due to STAFFING and TIME constraints, PRIORITIZATION with COMPLEXITY being the primary driver
case management is provided based on...
Ensuring that required services meet BROKER and FACILITATOR
insurance coverage and limits by acting as a
Medicaid a program that covers LOWER INCOME individuals (ex:
AHCCCS)
Medicare a program that cover individuals AGE 65 AND OLDER (also
covers certain chronic conditions and disabilities)
care plan includes the individual and multidisciplinary patient
life care planning is utilized for CATASTROPHIC injury
critical pathway Management plans that DISPLAY GOALS for and PROVIDE
the SEQUENCE and TIMING of actions necessary to ACHIEVE
these goals with OPTIMAL EFFICIENCY
Poor coordination of care may result in FRAGMENTATION and DUPLICATION
Fragmented care different clinical and/or organizations WORKING in SILOS
instead of effectively work together
Advocacy the promotion of patient RIGHTS and SELF-DETERMINATION
Risk mitigation includes several important -documentation
factors including... -referrals
documentation - Clear and concise INTERDICIPLINARY COMMUNICATION
- Patient INVOLVEMEMNT
- RATIONALE for decisions
- Education: INFORMING patients of their RIGHTS
referrals Vetting CREDENTIALS and CAPABILITIES
, case management coordination on all levels, providers, insurance, individual
includes the activities implemented with individual clients in
the system
care management a program or process that established systems and monitors
the health status of individuals, families, and/or groups
case managers advocates who help patients understand their current health
status, what they can do about it and why those treatments are
important
coordinating conscious activity of assembling and directing the work
efforts of a group of health providers so that they can function
harmoniously in the attainment of the objective of client care.
broker Acts as an agent for provider services that are needed by
clients to stay within coverage according to the budget and
cost limits of a health care plan
consultant Case manager who works with providers, suppliers, the
community, and other case managers to provide case
management expertise in programmatic and individual
applications
coordinator Arranges, regulates, and coordinates needed health care
services for clients at all necessary points of services
educator Educates the client, family, and providers about the case
management process, delivery system, community health
resources, and benefit coverage so that informed decisions
can be made by all parties
facilitator Supports all parties in work toward mutual goals
liasion Provides a formal communication link among all parties
concerning the plan of care management
mentor Case manager who counsels and guides the development of
the practice of new case managers
patient advocate Acts as an advocate, provides information, and supports
benefit changes that assist member, family, primary care
provider, and capitated systems
Six "rights" of case management are... are right care, right time, right provider, right setting, and right
price/value
Which care delivery method is based on a.case management
organizing
and executing client-centered care?
a.case management
b.health maintenance
c.primary care
d.emergent care
Save
Students also studied
Sherpath: Diabetes Mellitus Chapter 21 Test Case Study 4 (Short
30 terms 24 terms 22 terms
jesssbee Preview kenanderson2017 Preview Brittany182
Terms in this set (78)
What s a part of coordination of care for management and implementation
individual clients?
Due to STAFFING and TIME constraints, PRIORITIZATION with COMPLEXITY being the primary driver
case management is provided based on...
Ensuring that required services meet BROKER and FACILITATOR
insurance coverage and limits by acting as a
Medicaid a program that covers LOWER INCOME individuals (ex:
AHCCCS)
Medicare a program that cover individuals AGE 65 AND OLDER (also
covers certain chronic conditions and disabilities)
care plan includes the individual and multidisciplinary patient
life care planning is utilized for CATASTROPHIC injury
critical pathway Management plans that DISPLAY GOALS for and PROVIDE
the SEQUENCE and TIMING of actions necessary to ACHIEVE
these goals with OPTIMAL EFFICIENCY
Poor coordination of care may result in FRAGMENTATION and DUPLICATION
Fragmented care different clinical and/or organizations WORKING in SILOS
instead of effectively work together
Advocacy the promotion of patient RIGHTS and SELF-DETERMINATION
Risk mitigation includes several important -documentation
factors including... -referrals
documentation - Clear and concise INTERDICIPLINARY COMMUNICATION
- Patient INVOLVEMEMNT
- RATIONALE for decisions
- Education: INFORMING patients of their RIGHTS
referrals Vetting CREDENTIALS and CAPABILITIES
, case management coordination on all levels, providers, insurance, individual
includes the activities implemented with individual clients in
the system
care management a program or process that established systems and monitors
the health status of individuals, families, and/or groups
case managers advocates who help patients understand their current health
status, what they can do about it and why those treatments are
important
coordinating conscious activity of assembling and directing the work
efforts of a group of health providers so that they can function
harmoniously in the attainment of the objective of client care.
broker Acts as an agent for provider services that are needed by
clients to stay within coverage according to the budget and
cost limits of a health care plan
consultant Case manager who works with providers, suppliers, the
community, and other case managers to provide case
management expertise in programmatic and individual
applications
coordinator Arranges, regulates, and coordinates needed health care
services for clients at all necessary points of services
educator Educates the client, family, and providers about the case
management process, delivery system, community health
resources, and benefit coverage so that informed decisions
can be made by all parties
facilitator Supports all parties in work toward mutual goals
liasion Provides a formal communication link among all parties
concerning the plan of care management
mentor Case manager who counsels and guides the development of
the practice of new case managers
patient advocate Acts as an advocate, provides information, and supports
benefit changes that assist member, family, primary care
provider, and capitated systems
Six "rights" of case management are... are right care, right time, right provider, right setting, and right
price/value
Which care delivery method is based on a.case management
organizing
and executing client-centered care?
a.case management
b.health maintenance
c.primary care
d.emergent care
