CARE MANAGER CERTIFICATION EXAMINATION

Transcription

1 CARE MANAGER CERTIFICATION EXAMINATION Handbook for Candidates Application Deadline: February 15, 2015 Testing Begins: April 1, 2015 Testing Ends: April 30, 2015 Application Deadline: August 15, 2015 Testing Begins: October 1, 2015 Testing Ends: October 31, 2015 National Academy of Certified Care Managers

2 TABLE OF CONTENTS CERTIFICATION... 1 PURPOSES OF CERTIFICATION... 1 ADMINISTRATION... 1 ELIGIBILITY REQUIREMENTS... 2 APPLICATION PROCESS... 6 FEES... 6 REFUNDS... 6 EXAMINATION ADMINISTRATION... 7 SCHEDULING YOUR EXAMINATION APPOINTMENT... 7 SPECIAL NEEDS... 8 CHANGING YOUR EXAMINATION APPOINTMENT... 8 RULES FOR THE EXAMINATION... 8 REPORT OF RESULTS... 9 REEXAMINATION... 9 ATTAINMENT OF CERTIFICATION AND RECERTIFICATION... 9 REVOCATION OF CERTIFICATION... 9 CONFIDENTIALITY ONLINE PRACTICE TEST IN CARE MANAGEMENT CONTENT OF EXAMINATION CONTENT DOMAINS CONTENT DOMAINS AND CARE MANAGER TASKS SAMPLE EXAMINATION QUESTIONS REFERENCES This handbook contains necessary information about the Care Manager Certification Examination. Please retain it for future reference. Candidates are responsible for reading these instructions carefully. This handbook is subject to change. National Academy of Certified Care Managers 3275 West Ina Road, Suite 130 Tucson, AZ [email protected]

3 CERTIFICATION The National Academy of Certified Care Managers (NACCM) endorses the concept of voluntary, periodic certification by examination for all individuals specializing in care management. Certification is one part of a process called credentialing. It focuses specifically on the individual and is an indication of current competence in a specialized area of practice. Certification as a care manager is highly valued and provides formal recognition in the profession of care management. PURPOSES OF CERTIFICATION TO PROMOTE DELIVERY OF SAFE AND EFFECTIVE CARE AS A CARE MANAGER AND TO ADVANCE THE QUALITY OF CARE MANAGEMENT SERVICES IN LONG-TERM CARE THROUGH THE CERTIFICATION OF QUALIFIED CARE MANAGERS BY: 1. Recognizing formally those individuals who meet the eligibility requirements of the National Academy of Certified Care Managers and pass the Care Manager Certification Examination. 2. Encouraging continued personal and professional growth in the practice of care management. 3. Establishing and measuring the level of knowledge required for the standardized practice regarding care management. 4. Providing a standard of knowledge requisite for certification; thereby assisting the employer, consumers, public, and members of the health professions in the assessment of care managers. ADMINISTRATION The Certification Program is sponsored by the National Academy of Certified Care Managers (NACCM). The Care Manager Certification Examination is administered for the NACCM by the Professional Testing Corporation (PTC), 1350 Broadway - 17th Floor, New York, New York 10018, (212) , Questions concerning the examination should be referred to PTC. Page 1

4 ELIGIBILITY REQUIREMENTS Candidates must meet ONE of the following eligibility criteria at the time of the application deadline: For all three criteria options: Fields related to care management may include: social work, counseling, nursing, psychology, gerontology, RN diploma, rehabilitation, public health, or human services. Care management experience and direct client experience must not run concurrently (unless it is part-time work experience). Internship, preceptor-ship, practicum and volunteer activities are NOT accepted employment/experience. Page 2

5 In determining eligibility, care management work experience must be post eligibility degree and applicant must be currently working in the field of care management. NACCM will consider employment experiences within the last 10 years toward eligibility. Page 3

6 Care Management experience MUST include All FIVE core functions listed below: Assessment Assess and identify client strengths, needs, concerns, and preferences via a person-centered comprehensive assessment. The comprehensive assessment must include physical and mental health, function, behavior, social, cognition, environment, spirituality, support system, and finances. Care managers follow clients across settings and work with care managers of specific settings and gather information from appropriate sources within HIPAA guidelines. 1. Planning Establish goals and a care plan reflecting the client s needs and preferences and available resources. Goals are client centered and measurable. 2. Implementation Coordinate and implement the care plan by referring, educating, negotiating and mediating with client, family, formal and informal providers in order to meet all client needs. 3. Monitoring Manage and monitor the ongoing provision of and need for direct care and care management including periodic formal reassessments. 4. Professional Practice and Evaluation Ensure professional practice through quality evaluation as evidenced by adherence to standards of practice and ethical guidelines, recognition and respect for diversity, and participation in quality evaluation activities. 5. Consultation/Supervision is defined as individual, group or peer review of performance, use of clinical skills, and core care manager functions. Supervision/consultation can be provided by professional colleagues, mentors, clinical supervisors, or program managers who are preferably (but not required to be) certified in care management. Each year of required care management experience must include 50 hours of consultation/supervision. Consultation/Supervision may be formal and/or informal. Content of consultation/supervisory activities is expected to include: The use of clinical skills and core care manager functions Record review Case examples Current practice issues Ethical dilemmas Care management interventions, and Quality evaluation measures Page 4

7 Conversion Chart: Part Time Work Experience to Full Time Work Experience Please use the following formula when calculating Part Time Work Experience. An example has been provided for you for an individual who worked 15 hours/week from January 2011 July 31, (The numbers in red will be your part time hours and calculations). 15 p/t hours per week Total # hours worked 4.3 weeks in a month # hrs/ month of FTE Hours in a month # of months between 1/20117/31/ months full-time of (2 years 7 months) Which is equivalent to 1 year and 1.28 months of full time employment Page 5

8 APPLICATION PROCESS Step 1 Complete Application and Upload Required Documents Go to to view examination testing windows, application deadline, and link to the online application. Complete the online application and upload required documentation. You must complete the examination application in full, using your name exactly as it appears on your current government issued photo ID such as a driver s license or a passport. Applications are not considered complete until all information has been provided. The completed application, with all required documentation, can be submitted and paid for online. Retain the link to the application and your login information. Step 2 - Submit Application for Review Receive from PTC stating that your application has been received. Step 3 Receive Approval of Application Receive from PTC stating that your application has been approved. Step 4 Submit Payment for Examination Application Return to your online application and submit payment. The payment must be submitted when the approval notice is received. Step 5 Receive Eligibility Notice and Schedule Testing Appointment Within six (6) weeks prior to the start of the testing period, you will receive an Eligibility Notice from PTC via . The Eligibility Notice includes an eligibility number and information on how to set up your examination location, date, and time through PSI. Retain this document. A printed copy of the Eligibility Notice must be presented along with your current government-issued photo identification, such as driver s license or passport at the testing center at the time of your examination appointment. FEES Application fee for the Care Manager Certification Examination... $ Fees must be submitted in U.S. dollars. Visa, MasterCard, and American Express are accepted. After your application is approved, you will be prompted to pay online using a credit card. Checks can also be accepted. Follow the directions on the online application to pay using a check. Checks must be made payable to Professional Testing Corporation. REFUNDS There will be no refund of fees. Fees will not be transferred from one testing period to another. Page 6

9 EXAMINATION ADMINISTRATION The Care Manager Certification Examination will be administered April 1-30, and October 1-31, 2015, Monday through Saturday, excluding holidays, at computer-based testing facilities managed by PSI. PSI has several hundred testing sites in the United States, as well as Canada. Scheduling is done on a first-come, first-served basis. To find a testing center near you visit: or call PSI at (800) Please note: hours and days of availability vary at different centers. You will not be able to schedule your examination appointment until you have received an Eligibility Notice from PTC. ONLINE TUTORIAL A free Testing Tutorial can be viewed online. Go to This document can give you an idea about the online testing features. SCHEDULING YOUR EXAMINATION APPOINTMENT Once your Application and fee have been received and processed and your eligibility verified, you will be sent an Eligibility Notice via within 6 weeks prior to the start of the testing period. A paper copy of your Eligibility Notice plus your current government-issued photo identification, such as a driver s license or passport, must be presented in order to gain admission to the testing center. A candidate not receiving an Eligibility Notice three weeks before the testing period begins should contact the Professional Testing Corporation by telephone at (212) Eligibility Notices presented on a cell phone, tablet, or other electronic devices will not be accepted. The Eligibility Notice will indicate how to schedule your examination appointment. Appointment times are firstcome, first-served, so schedule your appointment as soon as you receive your Eligibility Notice in order to maximize your chance of testing at your preferred location and on your preferred date. After you make your test appointment, PSI will send you a confirmation with the date, time, and location of your exam. Please check this confirmation carefully for the correct date, time, and location. Contact PSI at (800) if you do not receive this confirmation or if there is a mistake with your appointment. It is your responsibility as the candidate to contact PSI to schedule the examination appointment. It is highly recommended that each candidate becomes familiar with the testing site location prior to the scheduled testing date. Arrival at the testing site at the appointed time is the responsibility of the candidate. Please plan for weather, traffic, parking, and any security requirements that are specific to the testing location. Late arrival may prevent you from testing. Page 7

10 SPECIAL NEEDS Special testing arrangements may be made for special needs individuals submitting the Application, examination fee, all required documentation, and a completed and signed Request for Special Accommodations Form, available from or by calling PTC at (212) Requests for special testing needs individuals must be received at least EIGHT weeks before the preferred testing date. Please notify PTC at least two weeks prior to your test appointment if you have a medical condition that necessitates that you bring a service dog, medicine, food, or beverages with you to the test center. CHANGING YOUR EXAMINATION APPOINTMENT If you need to cancel your examination appointment or reschedule to a different date within the testing period, you must contact PSI at (800) no later than noon, Eastern Standard Time, of the second business day PRIOR to your scheduled appointment. PSI does not have the authority to authorize refunds or transfers to another testing period. If you fail to arrive for your appointment or cancel without giving the required notice, you will forfeit your testing fee. RULES FOR THE EXAMINATION 1. Electronic devices, including but not limited to, cell phones, pagers, Bluetooth type devices, MP3 players such as ipods, cameras, voice recorders, laptop computers, and tablets cannot be used during the examination and must be turned off. 2. No papers, books, or reference materials may be taken into or out of the examination room. 3. Simple, nonprogrammable calculators are permitted with the exception of calculators as part of cellular phones, etc. A calculator is also available on screen if needed. 4. No questions concerning content of the examination may be asked during the testing session. The candidate should read carefully the directions that are provided on screen at the beginning of the examination session. 5. Candidates are prohibited from leaving the testing room while their examination is in session, with the sole exception of going to the restroom. Page 8

11 REPORT OF RESULTS Candidates will be notified in writing by Professional Testing Corporation within four weeks of the close of the testing window whether they have passed or failed the examination. Scores on the major areas of the examination and on the total examination will be reported. REEXAMINATION The Care Manager Certification Examination may be taken as often as desired upon filing of a new Application and fee. There is no limit to the number of times an examination may be repeated. ATTAINMENT OF CERTIFICATION AND RECERTIFICATION Eligible candidates who pass the Care Manager Certification Examination will be certified and acknowledged by NACCM as Care Manager, Certified, are eligible to use the designation CMC after their names, and will receive certificates from NACCM. A registry of CMCs will be maintained by NACCM and may be reported in its publications. Certification as a Care Manager, Certified is recognized for a period of three years at which time the candidate must meet the recertification requirements that are in effect at that time in order to retain certification. Candidates not meeting the recertification requirements must retake and pass the current Care Manager Certification Examination. Go to for further information regarding recertification. REVOCATION OF CERTIFICATION Misconduct leading to revocation of the CMC may include but is not limited to: Falsification of any information in the certification application process; Any irregularities in relationship to the testing process; Failure to maintain any eligibility requirements; Falsification of any information contained in the recertification process; Misrepresentation or misuse of certification status; Failure to pay initial or renewal fees; Revocation of a license in a primary profession; Actions that lead to limitations or sanctions imposed by another professional organization/association; Any illegal practices. NACCM reserves the right to revoke the certification of any individual who is found and determined by its internal processes to violate any of the above and to publish certification revocations. Page 9

12 CONFIDENTIALITY 1. The NACCM will release the individual test scores ONLY to the individual candidate. 2. Any questions concerning test results should be referred to NACCM or the Professional Testing Corporation. ONLINE PRACTICE TEST IN CARE MANAGEMENT WHAT IT IS: A practice test to provide candidates with a better understanding of what the actual certification examination is like. Each practice test consists of 50 questions, has a testing time of two hours, and is taken over the internet. WHEN: Available starting in March WHY TAKE IT: To experience taking a computerized exam, to review an example of the type of content included in the Certification Examination, and to learn more about question format, style, and level of difficulty. SCORE REPORT: After completing the online practice test, you will receive an instant score report showing test performance in each of the content areas. The score report does not provide correct answers or indicate which questions were answered correctly or incorrectly. Once the practice test is scored, you cannot return to the test to review the questions. NOTE: Performance on the online practice test may differ from actual performance on the Certification Examination. Thus, there is no guarantee that taking this practice test will help you pass the Certification Examination. Candidates may, however, find it helpful to review content area in any areas of weakness indicated on the score report prior to taking the Certification Examination. CONTENT INCLUDED IN THE ONLINE PRACTICE TEST IN CARE MANAGEMENT I. Assess and Identify Client Strengths, Needs, Concerns, and Preferences II. Establish Goals and a Plan of Care III. Implement Care Plan IV. Manage and Monitor the Ongoing Provision of and Need for Care V. Ensure Professional Practice FEE: $70, payable by credit card online at QUESTIONS: Call Page 10

13 CONTENT OF EXAMINATION 1. The Care Manager Certification Examination is a computer-based examination composed of a maximum of 200 multiple-choice, objective questions with a total testing time of four (4) hours. 2. The content for the examinations is described in the Content Domains and Care Manager Tasks starting below. 3. The questions for the examinations are obtained from individuals with expertise in practicing care management and are reviewed for construction, accuracy, and appropriateness by the NACCM. 4. The NACCM, with the advice and assistance of the Professional Testing Corporation, prepares the examination. CONTENT DOMAINS THE CARE MANAGER CERTIFICATION EXAMINATION WILL BE WEIGHTED IN APPROXIMATELY THE FOLLOWING MANNER: I. II. III. IV. V. Assess and Identify Client Strengths, Needs, Concerns, and Preferences... 26% Establish Goals and a Plan of Care... 17% Implement Care Plan... 19% Manage and Monitor the Ongoing Provision of and Need for Care...24% Ensure Professional Practice... 14% Page 11

14 CONTENT DOMAINS AND CARE MANAGER TASKS The examination questions contain content from the following domains. The approximate percentage of questions from each domain is also indicated. Domain I. Assess and identify client strengths, needs, concerns, and preferences (26%) 1. Screen potential clients in order to determine the appropriateness of and eligibility for services and assist the client in making informed choices regarding care management. 2. Explain and discuss the role of the care manager, program parameters, and client rights and responsibilities in order to proceed with the structured assessment process. 3. Perform face-to-face assessment of the client s situation by interviewing, observing, and administering structured instruments, in order to collect data about the client s physical and mental health, function, behavior, cognition, socialization, environment, spirituality, finances, and support system. 4. Verify assessment data by contacting relevant sources such as physician(s), social support systems, and other care providers in order to validate and expand the information obtained. 5. Synthesize and interpret the assessment data by reviewing all available information in order to identify areas of concern. 6. Document all intake and assessment information in order to create a client record for baseline data, statistical analysis, and for quality improvement measures. Domain II. Establish goals and a plan of care (17%) 1. Prioritize areas of concern in collaboration with client and support system in order to identify potential areas for intervention. 2. Identify service options and resources that address the areas for intervention, and discuss their advantages, disadvantages, and costs with the client in order to establish mutually agreed upon goals. 3. Develop action steps in order to achieve the agreed upon care plan goals. 4. Document care plan, including formal and informal providers and the frequency, intensity, duration, cost, and source of payment for services, in order to develop a baseline for tracking, accountability, and quality measurement. Page 12

15 Domain III. Implement care plan (19%) 1. Coordinate services and interventions by referring, educating, negotiating, and mediating with client and formal and informal providers in order to meet goals of care plan. 2. Counsel, educate, negotiate, and mediate with client and social support system in order to strengthen and sustain the social support system, identify health promotion behaviors, and meet goals of care plan. 3. Document referrals, coordination of services, and action steps taken related to the provision of services and progress toward goals. Domain IV. Manage and monitor the ongoing provision of and need for care (24%) 1. Monitor delivery and quality of services and interventions provided in order to assure that agreed upon plan of care was implemented. 2. Perform ongoing monitoring and reassessment of client status and satisfaction with service in order to evaluate progress toward goal achievement, and determine need for and make adjustments to care plan. 3. Document monitoring activities and client status in order to record actions taken and progress toward goal achievement. 4. Discontinue services when client no longer needs or desires services, or becomes ineligible for services, and document discharge plan in client record. Domain V. Ensure professional practice (14%) 1. Advocate for client autonomy by mediating between values and needs of consumer and society in order to preserve client right to self-determination. 2. Recognize and respect diversity with respect to factors such as culture, religion, ethnicity, gender, sexual orientation, and socioeconomic status, in order to uphold client s value system, preferences, and choices. Adhere to agency/company guidelines. 3. Adhere to standards of practice, agency/company policies and procedures, and applicable ethical guidelines in order to maintain professional accountability and to protect client rights. 4. Work through ethical dilemmas by identifying the issue(s), consulting with an interdisciplinary team, and identifying strategies in order to preserve client rights and resolve the dilemma. 5. Evaluate and document care management services using tools such as peer review, record auditing, client satisfaction surveys, and grievance procedures and take corrective action in order to promote the quality of care management practice. Page 13

16 Knowledge Required To Perform Care Manager Tasks Theoretical Bases human development theory personality theory behavior theory systems theory family systems theory organizational behavior crisis theory adult learning theory change theory Assessment health issues for individuals with chronic health concerns or disabilities functioning as it relates to all activities of daily living including: transfer, walking, wheeling, bowel, bladder, toileting, mobility, bathing, dressing, eating, feeding functioning as it relates to all instrumental activities of daily living including: medication, meal prep, shopping, housekeeping, laundry, telephone, travel, finances common emotional disorders and their symptoms techniques for administering and interpreting of structured cognitive screening tools (orientation, memory, and judgment), and behavioral, emotional, and life satisfaction assessment tools risk assessment techniques interviewing techniques for collecting demographic, environmental, social system, and financial information basic nutritional and hydration needs as wells as special requirements relating to individuals with chronic health concerns or disabilities common medications relating to individuals with chronic health concerns or disabilities impact of diversity in areas such as culture, religion, ethnicity, gender, sexual orientation, and socioeconomic status on behavior, perceptions and value systems that relate to health care substance abuse preferences, expectations, capabilities, limitations, stress, and coping mechanisms of the client and others and their impact on the client system the impact of interactions between the formal and informal support systems the impact of spirituality on health the impact of health status and functional abilities on behavior and emotions advanced directives such as power of attorney, living will, health care surrogate indicators that client is at risk for financial exploitation indicators that client is in need of guardian/conservator abuse, neglect, and exploitation issues grief and loss requirements of the Americans with Disabilities Act data analysis and interpretation legal and financial vehicles for financing care such as special needs trusts communicable diseases including MRSA, TB, HIV Page 14

17 Care Planning care planning process how to write goals that are specific, measurable, agreed upon, realistic, and time limited reimbursement mechanisms such as health insurance, supplemental insurance, long-term care insurance entitlement programs such as Medicare and Medicaid, Veterans Administration, SSD, SSI, and their eligibility requirements options for financing care such as reverse mortgages, equity loans, annuities budgeting and cost-benefit analysis social, environmental, and medical services available to enhance function such as durable medical equipment, respite, day treatment, home adaptation intervention strategies, such as medication management, treatment modalities, crisis intervention, psychosocial interventions housing options such as assisted living, continuing care retirement communities (CCRCs), intentional communities alternative/complementary services such as acupuncture and massage end of life planning hospice and palliative care Coordination of Care formal and informal provider responsibilities availability and use of interpreters and adaptive communication equipment appropriate record keeping and documentation referral procedures to service providers emotional, physical, geographical, financial, and/or cultural barriers to service delivery interdisciplinary team building and techniques to enhance inter-organizational relations Professional Practice legal and ethical issues of reporting abuse and neglect grievance procedures and complaints appeals processes (entitlement appeals, professional grievance procedures) applicable standards of practice and ethical guidelines HIPAA informed consent professional liability client advocacy procedures client empowerment strategies guardianship/conservatorship process client rights and responsibilities peer review processes record audit process community outreach and education techniques outcome measurement and quality assurance practices Page 15

18 Generic Competencies decision making conflict resolution techniques stress management techniques time management techniques counseling techniques crisis intervention techniques motivational techniques negotiation and mediation strategies problem solving techniques interpersonal relations communication techniques group dynamics organizational skills teaching and coaching techniques networking techniques prioritization Page 16

19 SAMPLE EXAMINATION QUESTIONS 1. Which of the following activities represent ADLs? 1. Dusting, vacuuming, mowing the lawn 2. Paying the rent, answering the phone, reading the newspaper 3. Walking up porch steps, operating a motorized wheelchair, washing hair, tying shoes 4. Folding laundry, preparing sandwiches, removing clothing from the washing machine 2. The statement, All consumers are unique individuals with unique care needs to be respected and considered, and self-directed, defines the concept of 1. client s right to care. 2. government standards for care. 3. legal principles for care delivery. 4. client s authorization for procedures/treatment. 3. In order to obtain medical information on a consumer, a care manager must 1. ask the consumer for the information. 2. ask the consumer s physician for the information. 3. obtain a signed authorization from the consumer for release of the information. 4. obtain a signed authorization from the consumer s physician for release of the information. 4. Good health practice requires that a person with a hearing loss should first 1. go to a hearing aid specialist for a test. 2. enroll in an aural rehabilitation program. 3. join a support group to learn coping strategies. 4. have a medical evaluation by a primary care provider. 5. What is the most common configuration used in a team approach to assessment? 1. Intake worker and social worker 2. Registered nurse and social worker 3. Registered nurse and occupational therapist 4. Occupational therapist and physical therapist 6. On the initial visit to assess an adult consumer s eligibility for services, a care manager finds the consumer in soiled clothing and her home in disarray. She is alone and disoriented and says she is hungry and does not know where her daughter is. After returning to the office, the care manager should 1. call the consumer s physician. 2. file a report with Adult Protective Services. 3. request that meal delivery begin immediately. 4. contact the police and report the daughter missing. CORRECT ANSWERS TO SAMPLE QUESTIONS Page 17

20 REFERENCES The National Academy of Certified Care Managers has prepared a suggested reference list to assist in preparing for the Care Manager Certification Examination. These references contain journals and textbooks which include information of significance to Care Managers. This list does not attempt to include all acceptable references nor is it suggested that the Care Manager Certification Examination is necessarily based on these references. Applebaum, R. & White, M, (Eds), Key Issues in Case Management Around the Globe. San Francisco, CA: American Society on Aging. Berger, K. (2014). The Developing Person Through the Life Span, 9th Edition. New York: Palgrave Macmillan. Centers for Medicare and Medicaid Services, (2014), Medicare and You 2015, U.S. Department of Health and Human Services, Page 29. Cohen, Elaine L. and Cesta, Toni G. (2005). Nursing Case Management, 4th Edition, Elsevier Mosby, St. Louis, MO Cress, C., (2011). Handbook of Geriatric Care Management, 3rd Edition. Jones and Bartlett, Sudbury, MA. Evashwick, C. J., (2005). The Continuum of Long-Term Care, 3rd Edition. Clifton Park, NY: Delmar. Frankel, Arthur J. and Gelman, Sheldon R. (2012).Case Management: An Introduction to Concepts and Skills, Lyceum Books, Chicago, IL. **Geron, S. M. and D. Chassler, (1994), Guidelines for Case Management Practice Across the Long-Term Continuum, Bristol, CT, Available from Connecticut Community Care, Inc., (Best overall review) Griffith, Patrick A. and Lopez, Oscar L.,(2009) Disparities in the Diagnosis and Treatment of Alzheimer s Disease in African American and Hispanic Patients: A Call to Action, Generations, Vol.33 #1, Pg Holstein, PhD; Martha B. and Mitzen, ACSW, LCSW, Phyllis B. (2001). Ethics in Community-Based Elder Care, Springer Publishing Co., NY Kunkel, Suzanne R. and Wellin, Valerie, (2006). Consumer Voice and Choice in Long-Term Care, Springer Publishing Co., NY. Montgomery, Rhonda J.V. and Kosloski, Karl, (2009) Caregiving as a Process of Changing Identity: Implications for Caregiver Support, Generations, Vol. 33 #1. Mullahy, C.M. (2013) The Case Manager s Handbook, 5th Edition, Jones and Bartlett, Sudbury, MA. Page 18

21 National Vital Statistics Report, Leading causes of death, April 2008 page 7. Scharlach, A. E., Giunta, N., Mills-Dick, K., (2001). Case Management in Long-Term Care Integration: An Overview of Current Programs and Evaluations. Monograph for California Center for Long-Term Care Integration. Berkeley, CA: University of California, Berkeley, Center for the Advanced Study of Aging Services. Journals and publications related to Care or Case Management; Membership organizations and conferences such as National Association of Geriatric Care Managers (NAPGCM), Case Management Society of America (CSA), National Association of Social Workers (NASW) and American Nurses Association (ANA), are also beneficial, just to name a few. PTC14130 Page 19

22 Each candidate must document paid, full time, supervised (50 hrs/yr) care management practice that includes all care manager tasks. (See Content Domains and Care Manager Tasks in the Handbook for Candidates). Criteria 1 and 2: Two (2) years of paid, full-time*, supervised care management experience Criteria 3: Three (3) years of paid, full-time*, supervised care management experience If you have any questions, contact PTC at NACCM CMC EXAMINATION APPLICATION SUPERVISED CARE MANAGEMENT EXPERIENCE VERIFICATION FORM REQUIRED FOR ALL CANDIDATES PLEASE PRINT CLEARLY OR TYPE (may be completed by candidate or employer) 1. Candidate Name: 2. Agency/Organization: (At which employed for supervised care management experience) 3. Agency Address: (Street) (City) (State) (Zip) (Phone) 4. Position/Title of candidate at this agency: 5. Tasks Performed. Check Yes or No if you perform the following tasks. Domain I. Assess and identify client strengths, needs, concerns, and preferences Yes No 1. Screen potential clients in order to determine the appropriateness of and eligibility for services and assist the client in making informed choices regarding care management. 2. Explain and discuss the role of the care manager, program parameters, and client rights and responsibilities in order to proceed with the structured assessment process. 3. Perform face-to-face assessment of the client s situation by interviewing, observing, and administering structured instruments, in order to collect data about the client s physical and mental health, function, behavior, social, cognition, environment, finances and support system. 4. Verify assessment data by contacting relevant sources such as physician(s), social support systems, and other care providers in order to validate and expand the information obtained. 5. Synthesize and interpret the assessment data by reviewing all available information in order to identify areas of concern. 6. Document all intake and assessment information in order to create a client record for baseline data, statistical analysis, and for quality improvement measures. 1 of 4

23 NACCM CMC EXAMINATION APPLICATION SUPERVISED CARE MANAGEMENT EXPERIENCE - VERIFICATION FORM Domain II. Establish goals and a plan of care Yes No 1. Prioritize areas of concern in collaboration with client and support system in order to identify potential areas for intervention. 2. Identify service options and resources that address the areas for intervention, and discuss their advantages, disadvantages, and costs with the client in order to establish mutually agreed upon goals. 3. Develop action steps in order to achieve the agreed upon care plan goals. 4. Document care plan, including formal and informal providers and the frequency, intensity, duration, cost, and source of payment for services, in order to develop a baseline for tracking, accountability, and quality measurement. Domain III. Implement care plan Yes No 1. Coordinate services and interventions by referring, educating, negotiating, and mediating with client and formal and informal providers in order to meet goals of care plan. 2. Counsel, educate, negotiate, and mediate with client and social support system in order to strengthen and sustain the social support system, identify health promotion behaviors, and meet goals of care plan. 3. Document referrals, coordination of services, and action steps taken related to the provision of services and progress toward goals. Domain IV. Manage and monitor the ongoing provision of and need for care Yes No 1. Monitor delivery and quality of services and interventions provided in order to assure that agreed upon plan of care was implemented. 2. Perform ongoing monitoring and reassessment of client status and satisfaction with service in order to evaluate progress toward goal achievement, and determine need for and make adjustments to care plan. 3. Document monitoring activities and client status in order to record actions taken and progress toward goal achievement. 4. Discontinue services when client no longer needs or desires services, or becomes ineligible for services, and document discharge plan in client record. Domain V. Ensure professional practice Yes No 1. Advocate for client autonomy by mediating between values and needs of consumer and society in order to preserve client right to self-determination. 2. Recognize and respect diversity with respect to factors such as culture, religion, ethnicity, gender, sexual orientation, and socioeconomic status, in order to uphold client s value system, preferences, and choices. 3. Adhere to standards of practice and applicable ethical guidelines in order to maintain professional accountability and to protect client rights. 4. Work through ethical dilemmas by identifying the issue(s), consulting with an interdisciplinary team, and identifying strategies in order to preserve client rights and resolve the dilemma. 5. Evaluate and document care management services using tools such as peer review, record auditing, client satisfaction surveys, and grievance procedures and take corrective action in order to promote the quality of care management practice. PTC of 4

24 NACCM CMC EXAMINATION APPLICATION SUPERVISED CARE MANAGEMENT EXPERIENCE - VERIFICATION FORM 6. Date(s) of Employment at this Agency: / to / (month) (year) (month) (year) 7. Hours per week of care management employment during above dates: (Full-time employment is defined as a minimum of 35 hours per week of paid employment. Part-time employment can be used. Refer to the Handbook for a Part-Time to Full-Time Conversion Table) 8. Number of hours care manager was supervised each year during the employment dates listed above in #6: (Supervision may include but is not limited to case conferences with supervisors or peers, peer consultation of supervision, performance appraisal, client record reviews, and consumer satisfaction data. Note: 40 hours/week of employment does not equal 40 hours/week of supervision received) 9. Print Supervisor s name and credential* 10. Supervisor s Signature* 11. I hereby certify that all information furnished on this form is accurate, truthful and complete. I understand that false or misleading information on this form, whether by inclusion or omission, will result in the rejection of the application. **Signature of person completing or verifying the information on this form Date for the candidate i.e. director, supervisor or human resources rep, etc. Print Name & Title of above person Telephone PTC of 4

25 NACCM CMC EXAMINATION APPLICATION SUPERVISED CARE MANAGEMENT EXPERIENCE - VERIFICATION FORM Please note: Candidates in independent practice may not sign this form. (See Eligibility Requirements in Handbook for Candidates) Full-time employment is defined as a minimum of 35 hours per week of paid employment. Part-time employment will be pro-rated based on a 35 hour full time work week. This form must be submitted with the application and should not be returned separately. This form may be duplicated if needed for more than one employer. * The method and amount of supervision/ consultation must be documented by the provider of the supervision/ consultation. The Candidate may need to have one person verify hours of employment or practice and a different person verify supervision/ consultation. ** Care managers in individual or private practice or owners of a practice may not sign their own Supervised Care Management Experience Verification Form. A letter is required from a peer, board or advisory committee member, colleague, company attorney or accountant attesting to the number of hours per week of care management experience. The letter(s) for * and ** must be on official letterhead of the author, notarized and attached to the completed Supervised Care Management Experience Verification Form. Failure to provide the requested information in detail will deem the application incomplete. PTC of 4

26 DIRECT CLIENT EXPERIENCE VERIFICATION FORM Required for candidates using Criteria #2 and #3 only Document paid experience working directly with clients/consumers/patients in fields such as social work, nursing, mental health/counseling, human services or care management. Criteria #2 candidates: 1 year of full time direct client experience; Criteria #3 candidates: 2 years of full time direct client experience. Please note: Direct Client Experience must not run concurrently with the Supervised Care Management Experience documented on the Supervised Care Management Experience Verification Form (unless it is parttime work experience). If you have any questions contact PTC at PLEASE PRINT CLEARLY OR TYPE 1. Candidate Name: 2. Agency/Organization: 3. Address: (Street) (City) (State) (Zip) (Phone) 4. Position/Title of candidate: 5. Description of Responsibilities Related to Direct Care of Clients/Patients and Related Services: PTC14152

27 6. Date(s) of Employment: / to / (month) (year) (month) (year) 7. Number of hours per week of direct client contact/interaction during this employment period 8. I hereby certify that all information furnished on this form is accurate, truthful and complete. I understand that false or misleading information on this form, whether by inclusion or omission, will result in the rejection of the application. Signature of person completing or verifying the information on this form for the applicant i.e. director, supervisor or human resources rep, etc. Date Print name and title of above person Telephone Please note: This form may be duplicated if needed for more than two employers. Full-time employment is defined as a minimum of 35 hours per week of paid employment. Part-time employment will be prorated based on a 35 hour full time work week. This form must be submitted with the application and should not be returned separately. PTC14152