Unit 1: Introduction to Case Management

This unit covers the definition, philosophy, and goals of case management as well as the case managers' roles, functions, and activities. This provides you with a thorough understanding of the practice of case management and the role of the case manager. 

Unit 2: The Case Management Process

This unit provides comprehensive training on the case management process and case management assessment, as well as how to use the information obtained during the assessment to identify opportunities for case management intervention. You will learn how to create, implement, and coordinate a case management plan of care including the development of short and long term SMART goals. This allows you to immediately begin positively impacting clients, resulting in better outcomes.

Unit 3: Ethical, Legal, and Practice Standards

In this unit, you will learn the ethical, legal, and practice standards including CMSA’s Standards of Practice, case management ethics, privacy and confidentiality, legal and regulatory requirements, informed consent, and healthcare and disability-related legislation. This ensures you have a thorough understanding of the legal and practice standards applicable to case management.

Unit 4: Principles of Case Management

This unit covers the principles of case management practice including advocacy, client self-advocacy, client self-care management, client adherence, client empowerment, client engagement, client activation, and adherence to care regimen. In addition, you will be taught behavioral change theories and stages of change allowing you to assess the client and develop a plan of care based on the client’s stage of readiness.

Unit 5: Utilization Management and MCG

Utilization management concepts including extensive MCG training and practice. This includes case studies to review pre-service notification requests for medical necessity services, as well as to review clinical information for concurrent reviews, extending the length of stay for inpatients as appropriate, or referrals to other network providers. 

Unit 6: MCG Training-Inpatient & Surgical Care

This unit introduces MCG training and you will use MCG to assess appropriateness for a procedure or admission to acute care, identify the stage of the optimal recovery course or general treatment course a patient is in, criteria for discharge from acute care, apply available tools to the discharge planning process, compute if a patient meets observation vs inpatient criteria, identify when a stay extension is necessary and determine the appropriate length, and identify when the ISC-Rapid Review Guidelines are appropriate to use and demonstrate proper use.

Unit 7: MCG Training-General Recovery Care

In this unit, you will use MCG to apply the General Recovery Care guidelines, describe the focus of General Recovery Care, compare General Recovery Care and Inpatient & Surgical Care guidelines, know when to appropriately use General Recovery Care versus Inpatient & Surgical Care Guidelines, use the Clinical Indications to determine the appropriateness of admission to inpatient care, use the General Recovery Course to manage an inpatient stay, identify discharge planning resources included within General Recovery Care, and apply the discharge planning resource.

Unit 8: MCG Training-Home Care

In this unit, you will utilize MCG to use Clinical Indications to determine the appropriateness of admission to the home care setting, identify format and features that support appropriate use of the Clinical Indications for Admission, describe the format and features of the General Treatment Course, use the Recovery Course to manage a patient's home care status, and identify discharge planning resources included in Home Care.

Unit 9: MCG Training-Recovery Facility Care 

In this unit, you will use MCG to identify how to apply the Recovery Facility Care guidelines, define the levels of care addressed in Recovery Facility Care, use the Clinical Indications to determine the appropriateness of admission to sub-acute and inpatient rehabilitation levels of care, describe the levels of care covered by Recovery Facility Care, determine the appropriateness of care at the acute inpatient rehabilitation (IRF) and the sub-acute/skilled nursing facility (SNF) levels of care, use the General Treatment Course to manage a patient's recovery facility course of care, identify discharge planning resources included within Recovery Facility Care, and apply the discharge planning resources. 

Unit 10: Care Delivery

In this unit, you will be training on levels of care and care settings to promote appropriate levels of care are received by patient's in a timely manner. Also, you will learn transitions of care, discharge planning, and the summary of care record including The Joint Commission Standards related to these as well as CMS Conditions of Participation related to discharge planning.

Unit 12: Psychosocial Concepts and Support Systems

This unit covers psychosocial concepts and support systems including cultural, spiritual and religious factors, family dynamics, dual diagnosis, social determinants of health, crisis intervention strategies, and support programs. This training allows you to understand barriers to reaching desired outcomes and develop strategies to overcome these barriers.

Unit 13: Communication

In this unit, you will learn communication skills including conflict resolution strategies and negotiation techniques, as well as documentation and reporting, preparing you to maintain accurate records of all communications and interventions and provide timely verbal and written reports.

Unit 14: Quality

This unit covers quality and outcome evaluations and measurements including cost-benefit analysis and program evaluations equipping you to demonstrate the value you bring to your organization. You will also learn the standards and requirements of accreditation bodies such as URAC and JCAHO. This equips you to provide case management services that are consistent with accreditation standards.  

Unit 15: Reimbursement Methods and Managed Care Principles

This unit covers reimbursement methods and managed care principles including insurance principles, terminology, and concepts as well as a basic understanding of Medicaid, the ACA, Coordination of Benefits, and COBRA. Nurses in most settings are not involved in the reimbursement aspects of treating the patient. For this reason, a large amount of training is provided to ensure you have the knowledge needed to perform in your new role. Medicare basics, reimbursement under Medicare, the Medicare Two-Midnight Rule, and Value-Based Programs. Alternative financial resources equipping you to identify appropriate alternative and non-traditional resources and demonstrate creativity in managing each case.