Exam #1: Case Management Questions and
Answers Updated 2026
What is a case manager accountable for? - AnswerThe case manager is accountable for
collaboratively facilitating the assessment, planning, implementation and evaluation of care
coordination and care transitions in the acute care setting.
What are case managers advocates for? - AnswerNurse case managers serve as advocates for options
and services to meet the patient and family needs, while promoting quality, cost effective outcomes
for the assigned case types.
What are 5 key functions and responsibilities of a case manager? - Answer1. Coordination and
facilitation of care
2. Utilization and resource management
3. Tracking of avoidable delays
4. Transitional and discharge planning
5. Quality and process improvement
A nurse case manager must encompass a knowledge of the health care environment with regards to
what 4 aspects? - Answer1. Clinical
2. Business/Financial
3. Managerial
4. Professionalism
In the clinical setting, what type of assessment does the case manager perform? - AnswerPatient and
family interview and review of medical record
What type of planning is performed by the case manager in a clinical setting? - AnswerConsult with
the physician, health care team and patient/family - develop plan of care to facilitate a timely
discharge /transition plan
What type of implementation is performed by the case manager in the clinical setting? -
AnswerImplements the plan of care in a timely manner to facilitate accomplishment of goals and
interventions.
, What type of evaluations do case managers perform in the clinical setting? - AnswerReassessment
for any decline in status and plan revisions
What are 4 roles of the case manager in managing business/financial concerns? - Answer1. Ensure
that the level of care is appropriate and services are medically necessary
2. Proactively identify delays in care, delays in discharge and risk of readmission
3. Maintain competence of utilization review (inpatient vs. observation status)
4. Document avoidable delays/days
What are 5 managerial duties of the case manager? - Answer1. A nurse case manager must display
leadership skills in decision making and problem solving
2. Must actively participate in Interdisciplinary Team Meetings and maintain open communication
with physicians
3. Strive to make productive use of time through the setting of priorities
4. Foster an environment of professionalism
5. Utilize the Chain of Command effectively in addressing complex/unusual situations
What are 5 key points that the case manager is responsible for in instituting professionalism in the
profession? - Answer1. Integrate high ethical standards and core values
2. Hold self and others accountable
3. Perform work in an accurate and timely manner
4. Serve as a role model and mentor
5. Maintain current clinical knowledge and leadership skills
What is a clinical pathway? - AnswerA clinical pathway is a map of clinical practice for a particular
diagnosis - also known as care maps. It is a timeline for patient care activities which is used by all
disciplines
What are clinical pathways used to achieve? - AnswerClinical pathways have emerged as a popular
method to standardize care while reducing costs and improving quality of care
What term has Cone Health renamed their clinical pathways and why? - AnswerCone Health has
renamed them to "Patient Care Plan" in an attempt to make them more individualized
Answers Updated 2026
What is a case manager accountable for? - AnswerThe case manager is accountable for
collaboratively facilitating the assessment, planning, implementation and evaluation of care
coordination and care transitions in the acute care setting.
What are case managers advocates for? - AnswerNurse case managers serve as advocates for options
and services to meet the patient and family needs, while promoting quality, cost effective outcomes
for the assigned case types.
What are 5 key functions and responsibilities of a case manager? - Answer1. Coordination and
facilitation of care
2. Utilization and resource management
3. Tracking of avoidable delays
4. Transitional and discharge planning
5. Quality and process improvement
A nurse case manager must encompass a knowledge of the health care environment with regards to
what 4 aspects? - Answer1. Clinical
2. Business/Financial
3. Managerial
4. Professionalism
In the clinical setting, what type of assessment does the case manager perform? - AnswerPatient and
family interview and review of medical record
What type of planning is performed by the case manager in a clinical setting? - AnswerConsult with
the physician, health care team and patient/family - develop plan of care to facilitate a timely
discharge /transition plan
What type of implementation is performed by the case manager in the clinical setting? -
AnswerImplements the plan of care in a timely manner to facilitate accomplishment of goals and
interventions.
, What type of evaluations do case managers perform in the clinical setting? - AnswerReassessment
for any decline in status and plan revisions
What are 4 roles of the case manager in managing business/financial concerns? - Answer1. Ensure
that the level of care is appropriate and services are medically necessary
2. Proactively identify delays in care, delays in discharge and risk of readmission
3. Maintain competence of utilization review (inpatient vs. observation status)
4. Document avoidable delays/days
What are 5 managerial duties of the case manager? - Answer1. A nurse case manager must display
leadership skills in decision making and problem solving
2. Must actively participate in Interdisciplinary Team Meetings and maintain open communication
with physicians
3. Strive to make productive use of time through the setting of priorities
4. Foster an environment of professionalism
5. Utilize the Chain of Command effectively in addressing complex/unusual situations
What are 5 key points that the case manager is responsible for in instituting professionalism in the
profession? - Answer1. Integrate high ethical standards and core values
2. Hold self and others accountable
3. Perform work in an accurate and timely manner
4. Serve as a role model and mentor
5. Maintain current clinical knowledge and leadership skills
What is a clinical pathway? - AnswerA clinical pathway is a map of clinical practice for a particular
diagnosis - also known as care maps. It is a timeline for patient care activities which is used by all
disciplines
What are clinical pathways used to achieve? - AnswerClinical pathways have emerged as a popular
method to standardize care while reducing costs and improving quality of care
What term has Cone Health renamed their clinical pathways and why? - AnswerCone Health has
renamed them to "Patient Care Plan" in an attempt to make them more individualized
