CASE MANAGER CERTIFICATION
COMPREHENSIVE EXAM STUDY GUIDE
WITH COMPLETE SOLUTIONS
●● Target Populations
Answer: diagnosis, high utilizers, age & health status, procedure, LOS,
psychological factors, vocational, functional impairments, disability
●● Case finding and intake
Answer: ID member, obtain consent, communicating member needs to
others, ID members who need alternate levels of care
●● Provision of services
Answer: facilitate and coordinate, communicate with other healthcare
providers, monitor progress, review and modify healthcare services,
collaborate with stakeholders on CM plan, advocate for pt and family,
assure adherence to various standards
●● Evaluation and Case closure
Answer: collect, analyze and report data, evaluate quality of services,
ensure access to services, apply evidence based practices, close
relationship when appropriate, report termination to stakeholders,
education pt re illness prevention
,●● Utilization Management
Answer: evaluate appropriate level of care, communicate with payers
and healthcare providers, allocate resources, manage appeals and
denials, review pt condition for appropriateness of hospitalization, ID
cases that are at risk for complications
●● Psychosocial & economic issues
Answer: review pt social & financial resources, assess support network,
consider culture, evaluate ability of caregiver outside hospital setting,
determine eligibility for insurance coverage or charity services
●● Vocational issues
Answer: ID need for changes in home environment, eliminate access
barriers, determine need for specialized services, arrange vocational
assessment and services, coordinate job analysis to implement
modifications, manage return to work activities
●● Clinical Patient Care Role
Answer: Discuss preventive services, direct patient care, asses coping
skills, social supports, financial/insurance status, intervene when
problems ID'd, facilitate progress through healthcare system, arrange for
consultations with specialists, ensure transfer to appropriate levels of
care, collaborate with team
●● Managerial Leadership Role
, Answer: Evaluate quality of care, conduct chart reviews for UM, guide
care and interventions, facilitate communication among team, serve as
preceptor for CM's in training
●● Financial Business Role
Answer: Assess variances, ensure continuity, integration and coordinator
to avoid duplication or fragmentation, access information on case mix
indexes, practice patterns, and consumption of resources, ensure use of
necessary treatments & completed procedures with reimbursable time
frames
●● Information Management-Communication Role
Answer: Data collection & analysis of variances, quality assurance,
outcomes management, communication and dissemination of
information, generation of reports, presentation of information,
development and revision of policies and procedures, obtain
authorization for services from managed care organizations, reports
findings of UM activities
●● Professional Development-Career Advancement Role
Answer: Conduct research and utilize findings, promote evidence based
practices, advocate for pt and families, share into at public forums, train
novice CM's, participate in continuing ed, remain up to date with latest
practices
●● Purpose of CM
COMPREHENSIVE EXAM STUDY GUIDE
WITH COMPLETE SOLUTIONS
●● Target Populations
Answer: diagnosis, high utilizers, age & health status, procedure, LOS,
psychological factors, vocational, functional impairments, disability
●● Case finding and intake
Answer: ID member, obtain consent, communicating member needs to
others, ID members who need alternate levels of care
●● Provision of services
Answer: facilitate and coordinate, communicate with other healthcare
providers, monitor progress, review and modify healthcare services,
collaborate with stakeholders on CM plan, advocate for pt and family,
assure adherence to various standards
●● Evaluation and Case closure
Answer: collect, analyze and report data, evaluate quality of services,
ensure access to services, apply evidence based practices, close
relationship when appropriate, report termination to stakeholders,
education pt re illness prevention
,●● Utilization Management
Answer: evaluate appropriate level of care, communicate with payers
and healthcare providers, allocate resources, manage appeals and
denials, review pt condition for appropriateness of hospitalization, ID
cases that are at risk for complications
●● Psychosocial & economic issues
Answer: review pt social & financial resources, assess support network,
consider culture, evaluate ability of caregiver outside hospital setting,
determine eligibility for insurance coverage or charity services
●● Vocational issues
Answer: ID need for changes in home environment, eliminate access
barriers, determine need for specialized services, arrange vocational
assessment and services, coordinate job analysis to implement
modifications, manage return to work activities
●● Clinical Patient Care Role
Answer: Discuss preventive services, direct patient care, asses coping
skills, social supports, financial/insurance status, intervene when
problems ID'd, facilitate progress through healthcare system, arrange for
consultations with specialists, ensure transfer to appropriate levels of
care, collaborate with team
●● Managerial Leadership Role
, Answer: Evaluate quality of care, conduct chart reviews for UM, guide
care and interventions, facilitate communication among team, serve as
preceptor for CM's in training
●● Financial Business Role
Answer: Assess variances, ensure continuity, integration and coordinator
to avoid duplication or fragmentation, access information on case mix
indexes, practice patterns, and consumption of resources, ensure use of
necessary treatments & completed procedures with reimbursable time
frames
●● Information Management-Communication Role
Answer: Data collection & analysis of variances, quality assurance,
outcomes management, communication and dissemination of
information, generation of reports, presentation of information,
development and revision of policies and procedures, obtain
authorization for services from managed care organizations, reports
findings of UM activities
●● Professional Development-Career Advancement Role
Answer: Conduct research and utilize findings, promote evidence based
practices, advocate for pt and families, share into at public forums, train
novice CM's, participate in continuing ed, remain up to date with latest
practices
●● Purpose of CM
