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: 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 8: 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 9: 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 10: 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 11: 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.