Certified Case Manager 2024 Study Guide Questions and Correct Answer

Target Populations Ans--diagnosis, high utilizers, age & health status, procedure, LOS, psychological factors, vocational, functional impairments, disability Case finding and intake Ans--ID member, obtain consent, communicating member needs to others, ID members who need alternate levels of care Provision of services Ans--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 Ans--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 Ans--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 Ans--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