CM 500
Case Management: Theory & Process I
Course Information
This course is an intermediate course for the program and provides a comprehensive learning program for theory, structure and practice application of case management. The course utilizes a most authoritative textbook in the specialty of case management and presents all facets of the practice. You receive comprehensive education in the professional practice of case management including systems, reimbursements, legal issues, and professional practice issues. Students focus on case management as a care delivery system that is multidisciplinary with outcomes focused management. Students receive a comprehensive review of the theory, process and practice of case management. The utilization review process is presented as well as tool for its practice. Students also begin the study of reimbursement systems, including Medicare and Medicaid, managed care and commercial carriers. This is the first course in the study of the theory and process of case management. Course Code: CM 500. Contact hours of education = 25.
This course is particularly designed for those who would like to apply for Fellowship certification as a "Fellow" in the American Academy of Case Management.
BOARD APPROVALS: AIHCP is an approved provider of continuing education by the Florida Board of Nursing and the District of Columbia Board of Nursing. CE Provider # 50-11975. Access information
This is a guided, independent study CEU Course. You are to study and progress at your own rate. There are no written assignments. It is recommended that you follow this process for completing the course:
Instructor/Course Author: Dominick L. Flarey, Ph.D, MBA, RN,BC, CNAA, FACHE
Link to Resume
E-mail: info@aihcp.org
TIME FRAME: You are allotted two years from the date of enrollment, to complete all of the courses in this continuing education program (all five (5) courses). There are no set time-frames per course, other than the two year allotted time. If you do not complete the courses within the two-year time-frame, you will be removed from the course and an "incomplete" will be recorded for you in our records. Also, if you would like to complete the courses after this two-year expiration time, you would need to register and pay the course tuition fee again.
TEXTBOOK
Case Management: A Practical Guide for Education and Practice, 3rd edition, by Suzanne K. Powell & Hussein A. Tahan. Philadelphia: Lippincott, Williams & Wilkins, 2010. ISBN: 978-0-7817-9038-3.
AIHCP Online Bookstore: AIHCP provides an online bookstore stocked with all of the required textbooks, and/or materials required for its CE courses. To purchase this book online, click the access store link, go to the table of categories, right upper hand corner, and click on Case Management. Access AIHCP Store: click here
Instructor: Your instructor for this course is Dominick L. Flarey, Ph.D,MBA, RN,BC, CNAA, FACHE ,executive director of the American Academy of Case Management.. Access information
GRADING: You must achieve a passing score of at least 70% to complete this course and receive the 25 hours of awarded continuing education credit. There are no letter grades assigned. You will receive notice of your total % score. Those who score below the minimum of 70% will be contacted by the American Academy of Case Management and options for completing additional course work to achieve a passing score, will be presented.
Within 24-48 hours after submission of your completed examination for this course, you will receive from us an e-mail notification of your final score and more information about the shipping of your CEU certificate.
ONLINE COMMUNITY MESSAGE BOARDS: Enrolled students have full access to our online Student Community Message Boards. These message boards allow students in our CE courses to meet each other, communicate online, share information, discuss topics of study and interest and much more. Full access is provided via the online classrooms.
Fellowship Certification Information:
Once you have completed all of the five (5) courses in this education program, you are eligible for application and conferral of "Fellowship status and Certification" in the American Academy of Case Management. To access program information on Fellowship/Certification, click here.
COURSE OBJECTIVES:
Upon completion of this course, you will be able to:
1. Discuss the concept and theories of case management systems and operations in health care.
2. Define case management responsibilities in over all care delivery.
3. Define and discuss the essential skills for case managers today.
4. Review and discuss issues related to credentialing
5. Understand and discuss the various case management tools in use, including guidelines.
6. Review and discuss standards of care and practice for case management.
7. Review insurance plans, both government and private and how they impact care delivery.
8. Define and discuss the process and applications of utilization management.
9. Understand the multiple legal issues related to case management practice.
10. Begin to conceptualize and discuss the application of case management theory and structure to actual professional case management practice in health care settings.
11. Identify and discuss the common legal issues related to the practice of case management and liability issues of case managers.
12. Review and discuss legislation and other regulatory issues that affect and impact case management care delivery.
Course Content
1. Case management systems
2. Role of the case manager
3. Code of professional conduct
4. Models of case management
5. Disease management
6. Evaluation of case management models
7. International case management
8. Case management job responsibilities
9. Goals of case management
10. Essential skills for case managers
11. Patient advocacy
12. Multidisciplinary teams
13. Basic vs advanced skills
14. Practice guidelines
15. Standards of practice
16. Quality of care organizations
17. Regulatory agencies
18. Case management organization standards
19. NCQA and HEDIS
20. Reimbursement systems
21. Insurance models and systems
22. Medicare/Medicaid
23. Medicare managed care
24. Worker's compensation
25. Managed health care systems and models
26. Utilization Management
27. Telephonic case management
28. Utilization modalities
29. Tools for utilization management
30. Clinical pathways
31. Documentation and communication
32. Legal issues in case management