Nurse case manager test Exam
Questions and Correct Answers
(TPA)yThirdypartyyadministratory-yCORRECTyANSWER-
Organizationythatyprocessesyhealthyclaimsyandyotherybusinessyrelatedyfunctionsyofyhealthy
plan
3ytypesyofymeasurementsyofyperformanceyimprovementy-yCORRECTyANSWER-
1)yprocess
2)ystructure
3)youtcome
4ycomponentsyofyinterpersonalycommunicationy-yCORRECTyANSWER-sender
message
receiver
context
5ybasisyethicalyprinciplesy-yCORRECTyANSWER-Beneficence
Non-malfeasance
autonomy
justicey
fidelity
5ystagesyofychangey-yCORRECTyANSWER-1.yPrecontemplation
2.yContemplation
3.yPreparation
4.yAction
5.yMaintenance
Accreditationy-yCORRECTyANSWER-
entailsyvoluntaryysurveyyprocessythatyassessesytheyextentyofyayhealthcareyorganization'syc
omplianceywithytheystandardsytoyimproveypatientyoutcomes
ADAy-yAmericanyDisabilitiesyActydefinesyaydisabilityy-yCORRECTyANSWER-
1)yhasyayphysicalyorymentalyimpairmentythatylimitsyaymajorylifeyactivity
2)yhasyayrecordyoryhistoryyofyaysubstantiallyylimitingyimpairment
3)yisyregardedybyyERyasyhavingyaysubstantiallyylimitingyimpairment
4)yalsoyprotectsypriorydrugyaddictionyifytheyyhaveybeenyrehab'd.
Beneficencey-yCORRECTyANSWER-toydoygood
, CAGEytooly-yCORRECTyANSWER-cutydown,yannoyed,yguilty,yeyeyopener
Capitationy-yCORRECTyANSWER-Ayfixedyamountyofymoneyyper-member-per-
monthy(PMPM)ypaidytoyaycareyprovideryforycoveredyservicesyratherythanybasedyonyspecificy
servicesyprovided.yTheytypicalyreimbursementymethodyusedybyyHMOs.yWhetheryaymember
yusesytheyhealthyserviceyonceyorymoreythanyonce,yayproviderywho
isycapitatedyreceivesytheysameypayment
CARFy-yCommissionyonyAccreditationyofyRehabilitationyFacilitiesy-yCORRECTyANSWER-
Private,ynon-
profityestablishesystandardsyofyqualityyforyservicesytoypeopleyw/ydisabilities.yOffersyvoluntar
yyaccreditationytoyrehabyfacilities
CarveyOuty-yCORRECTyANSWER-
Servicesyexcludedyfromyayproviderycontractythatymayybeycoveredythroughyarrangementsywi
thyotheryproviders.yProvidersyareynotyfinanciallyyresponsibleyforyservicesycarvedyoutyofytheiry
contract.
Caseymanagementyprocess:y-yCORRECTyANSWER-Screening
Assessing
Stratifyingyrisk
planning
implementing
followingyup
transitioningy
communication
evaluation
COBy-yCoordinationyofyBenefitsy-yCORRECTyANSWER-
ayprogramyforydeterminingywhichyhealthyinsurerypaysyforyservicesyfirstywhenyaybeneficiaryyis
ycoveredybyymoreythanyoneyhealthycareyplan.yPrimaryyorysecondaryyinsuracne
Concurrentyreviewy-yCORRECTyANSWER-
reviewyforymedicalynecessityyofytestsyandyproceduresyorderedyduringyanyinpatientyhospitali
zation.yAnotheryformyofyURythatytracksyconsumptionyofyresourcesywhileyIEyisyhospitalized
Conflictyresolutionystrategiesy-yCORRECTyANSWER-1)collaboration
2)ynegotiation
3)yaccommodation
4)ycompetitive
5)yavoidance
continuedystayyreviewy-yCORRECTyANSWER-
usedytoydetermineythatyeachydayyofytheyhospitalystayyisynecessaryyandythatycareyisybeingyre
nderedyatytheyappropriateylevel.yItytakesyplaceyduringyaypatient'syhospitalizationyforycare.
Questions and Correct Answers
(TPA)yThirdypartyyadministratory-yCORRECTyANSWER-
Organizationythatyprocessesyhealthyclaimsyandyotherybusinessyrelatedyfunctionsyofyhealthy
plan
3ytypesyofymeasurementsyofyperformanceyimprovementy-yCORRECTyANSWER-
1)yprocess
2)ystructure
3)youtcome
4ycomponentsyofyinterpersonalycommunicationy-yCORRECTyANSWER-sender
message
receiver
context
5ybasisyethicalyprinciplesy-yCORRECTyANSWER-Beneficence
Non-malfeasance
autonomy
justicey
fidelity
5ystagesyofychangey-yCORRECTyANSWER-1.yPrecontemplation
2.yContemplation
3.yPreparation
4.yAction
5.yMaintenance
Accreditationy-yCORRECTyANSWER-
entailsyvoluntaryysurveyyprocessythatyassessesytheyextentyofyayhealthcareyorganization'syc
omplianceywithytheystandardsytoyimproveypatientyoutcomes
ADAy-yAmericanyDisabilitiesyActydefinesyaydisabilityy-yCORRECTyANSWER-
1)yhasyayphysicalyorymentalyimpairmentythatylimitsyaymajorylifeyactivity
2)yhasyayrecordyoryhistoryyofyaysubstantiallyylimitingyimpairment
3)yisyregardedybyyERyasyhavingyaysubstantiallyylimitingyimpairment
4)yalsoyprotectsypriorydrugyaddictionyifytheyyhaveybeenyrehab'd.
Beneficencey-yCORRECTyANSWER-toydoygood
, CAGEytooly-yCORRECTyANSWER-cutydown,yannoyed,yguilty,yeyeyopener
Capitationy-yCORRECTyANSWER-Ayfixedyamountyofymoneyyper-member-per-
monthy(PMPM)ypaidytoyaycareyprovideryforycoveredyservicesyratherythanybasedyonyspecificy
servicesyprovided.yTheytypicalyreimbursementymethodyusedybyyHMOs.yWhetheryaymember
yusesytheyhealthyserviceyonceyorymoreythanyonce,yayproviderywho
isycapitatedyreceivesytheysameypayment
CARFy-yCommissionyonyAccreditationyofyRehabilitationyFacilitiesy-yCORRECTyANSWER-
Private,ynon-
profityestablishesystandardsyofyqualityyforyservicesytoypeopleyw/ydisabilities.yOffersyvoluntar
yyaccreditationytoyrehabyfacilities
CarveyOuty-yCORRECTyANSWER-
Servicesyexcludedyfromyayproviderycontractythatymayybeycoveredythroughyarrangementsywi
thyotheryproviders.yProvidersyareynotyfinanciallyyresponsibleyforyservicesycarvedyoutyofytheiry
contract.
Caseymanagementyprocess:y-yCORRECTyANSWER-Screening
Assessing
Stratifyingyrisk
planning
implementing
followingyup
transitioningy
communication
evaluation
COBy-yCoordinationyofyBenefitsy-yCORRECTyANSWER-
ayprogramyforydeterminingywhichyhealthyinsurerypaysyforyservicesyfirstywhenyaybeneficiaryyis
ycoveredybyymoreythanyoneyhealthycareyplan.yPrimaryyorysecondaryyinsuracne
Concurrentyreviewy-yCORRECTyANSWER-
reviewyforymedicalynecessityyofytestsyandyproceduresyorderedyduringyanyinpatientyhospitali
zation.yAnotheryformyofyURythatytracksyconsumptionyofyresourcesywhileyIEyisyhospitalized
Conflictyresolutionystrategiesy-yCORRECTyANSWER-1)collaboration
2)ynegotiation
3)yaccommodation
4)ycompetitive
5)yavoidance
continuedystayyreviewy-yCORRECTyANSWER-
usedytoydetermineythatyeachydayyofytheyhospitalystayyisynecessaryyandythatycareyisybeingyre
nderedyatytheyappropriateylevel.yItytakesyplaceyduringyaypatient'syhospitalizationyforycare.
