DMEC CLMS CERTIFICATION 2026
COMPREHENSIVE REVIEW AND TESTED
CONCEPTS
◉ Trust vs. mistrust. Answer: Erickson 0-1 1/2
◉ Autonomy vs. shame. Answer: Erickson 1 1/5-3
◉ Initiative vs. guilt. Answer: Erickson 3-5
◉ Industry vs. inferiority. Answer: Erickson 5-12
◉ Ego id vs. role confusion. Answer: Erickson 12-18
◉ Intimacy vs. isolation. Answer: Erickson 18-40
◉ Generative vs. stagnation. Answer: Erickson 40-65
◉ Integrity vs. despair. Answer: Erickson 65+
◉ Skinner. Answer: Operational conditioning
,◉ CMAG. Answer: Case management adherence guidelines
◉ IM-CAG. Answer: Inter med - complexity assessment grid
◉ CMAG. Answer: assessment tool. Comprehensive approach to
chronic therapy issues, ex: med adherence, COPD, DVR,DM,HTN,
◉ IM-CAG. Answer: Electronic tool that provides risks and
vulnerabilities of complex patients with actionable interventions.
4 domains: behavioral, social, health system.
◉ evidence based practice. Answer: 1. Question
2. ID resources
3. Critically appraise resources
4. Apply evidence
5. Reevaluate application of evidence
are 5 steps of what?
◉ Integrated CM. Answer: Includes well being, disease management,
case management, prevention, triage, utilization management
,◉ Integrated case management. Answer: 3 functions of ----
1. Track patient self management
2. Tend/track population management
3. Reporting, monitoring quality
◉ Patient. Answer: Poor attitude, memory loss, literacy, pride, fear,
side effects, can't "see" results, decreased choices, finances are all ----
- barriers
◉ Patient. Answer: My med list, readiness ruler, Motivational
interviewing, modified morisky scale are all tools for ---- barriers
◉ Provider. Answer: No knowledge of patient, not familiar with
family preferences, lack of accountability are examples of ----
barriers
◉ System. Answer: Poor communication, not identified care
coordinators are ----- barriers
◉ Goal of CM. Answer: To ensure patients have the tools and
resources to help manage their needs, increase self confidence and
control and self management
, ◉ Physiological, safety, love, esteem, self-actualization. Answer:
Maslow's hierarchy of needs
◉ Resource management. Answer: Process of identifying,
confirming, coordinating, negotiating resources to meet needs
◉ Milliman care guidelines. Answer: Soft ware, evidence based
guidelines/tool for treating common conditions, chronic care, BH
- conducing, actionable, measurable
- helps cm coordinate care and anticipate needs
◉ InterQual. Answer: Clinical decision support tool determines
when and how a patient progresses through the continuum.
- organizes resources utilization,
- objective evidence based criteria for assessing appropriate care for
patients. Helps fraud/abuae
◉ Utilization management. Answer: Forward looking using evidence
based criteria to support decisions.
◉ Utilization review. Answer: Backward looking to ensure patient's
5 rights were observed
◉ 1. Provider
COMPREHENSIVE REVIEW AND TESTED
CONCEPTS
◉ Trust vs. mistrust. Answer: Erickson 0-1 1/2
◉ Autonomy vs. shame. Answer: Erickson 1 1/5-3
◉ Initiative vs. guilt. Answer: Erickson 3-5
◉ Industry vs. inferiority. Answer: Erickson 5-12
◉ Ego id vs. role confusion. Answer: Erickson 12-18
◉ Intimacy vs. isolation. Answer: Erickson 18-40
◉ Generative vs. stagnation. Answer: Erickson 40-65
◉ Integrity vs. despair. Answer: Erickson 65+
◉ Skinner. Answer: Operational conditioning
,◉ CMAG. Answer: Case management adherence guidelines
◉ IM-CAG. Answer: Inter med - complexity assessment grid
◉ CMAG. Answer: assessment tool. Comprehensive approach to
chronic therapy issues, ex: med adherence, COPD, DVR,DM,HTN,
◉ IM-CAG. Answer: Electronic tool that provides risks and
vulnerabilities of complex patients with actionable interventions.
4 domains: behavioral, social, health system.
◉ evidence based practice. Answer: 1. Question
2. ID resources
3. Critically appraise resources
4. Apply evidence
5. Reevaluate application of evidence
are 5 steps of what?
◉ Integrated CM. Answer: Includes well being, disease management,
case management, prevention, triage, utilization management
,◉ Integrated case management. Answer: 3 functions of ----
1. Track patient self management
2. Tend/track population management
3. Reporting, monitoring quality
◉ Patient. Answer: Poor attitude, memory loss, literacy, pride, fear,
side effects, can't "see" results, decreased choices, finances are all ----
- barriers
◉ Patient. Answer: My med list, readiness ruler, Motivational
interviewing, modified morisky scale are all tools for ---- barriers
◉ Provider. Answer: No knowledge of patient, not familiar with
family preferences, lack of accountability are examples of ----
barriers
◉ System. Answer: Poor communication, not identified care
coordinators are ----- barriers
◉ Goal of CM. Answer: To ensure patients have the tools and
resources to help manage their needs, increase self confidence and
control and self management
, ◉ Physiological, safety, love, esteem, self-actualization. Answer:
Maslow's hierarchy of needs
◉ Resource management. Answer: Process of identifying,
confirming, coordinating, negotiating resources to meet needs
◉ Milliman care guidelines. Answer: Soft ware, evidence based
guidelines/tool for treating common conditions, chronic care, BH
- conducing, actionable, measurable
- helps cm coordinate care and anticipate needs
◉ InterQual. Answer: Clinical decision support tool determines
when and how a patient progresses through the continuum.
- organizes resources utilization,
- objective evidence based criteria for assessing appropriate care for
patients. Helps fraud/abuae
◉ Utilization management. Answer: Forward looking using evidence
based criteria to support decisions.
◉ Utilization review. Answer: Backward looking to ensure patient's
5 rights were observed
◉ 1. Provider
