An Overview of Curriculum, Accreditation and Certification in the United States. Nancy E. Skinner, RN-BC, CCM

Transcription

1 An Overview of Curriculum, Accreditation and Certification in the United States Nancy E. Skinner, RN-BC, CCM

2 Objectives Detail the differences between Standards of Practice, Accreditation and Certification. Discuss academic avenues for case management education including certificate courses, baccalaureate programs and advanced degrees across all professional backgrounds. Detail essential components of case management educational offerings.

3 Curriculum

4 Curriculum Established by professional associations in collaboration with academic settings. Based on Standards of Practice Focused on healthcare professionals representing a number of disciplines Provide baccalaureate degrees, advanced degrees and certificate programs Available at numerous academic centers across the United States

5 Certification

6 Certification Overview and CMSA Certification Statistics? Certification is the act of confirming that someone has met a certain set of predetermined criteria by the certifying body. Certification is recognized as an acceptable standard of practice by general consent of the population it certifies. CMSA recognizes multiple certifications available today: AAOHN CCM CMC CRRN-A ABDA CCP CMCN CRRN ACM CCRNS COHN/CM COHN-S/CM AOCN CDMS CPHQ RN-BC CASWCM CHCQM CPON RN-C CSWCM CMAC CRC

7 American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) A Non-Profit Education & Certification Board Health Care Quality and Management Certification (HCQM)

8 ABQAURP Who Has Certified are ABQAURP Over 10,000 Health Diplomates? Care Professionals. Membership is comprised of virtually every type of health care professional. 60% Physicians from all Specialties 40% Nurses & Other Health Care Professionals from all Specialties Medical Director Chief Medical Officer President/Vice President Physician Advisor Case Manager/Management Sub-Specialty Certifications in: Case Management Transitions of Care Managed Care Risk Management/Patient Safety Workers Compensation Top 10 Positions: Associate Medical Director UR Nurses QA/UR Coordinator Directors of QA and/or UM Physician Reviewer

9 EHCQM Board Certification Candidates must meet the following criteria: Current, non-restricted license in each state/territory of the United States in which the candidate is licensed (as applicable to the candidate s profession) Documentation of active involvement in Health Care Quality within the past five years, minimum of 208 hours (2 hours per week for two years) in any of the exam Categories Two professional references Complete a minimum of twenty (20) hours of ABQAURP-approved Continuing Education (pertinent to at least one of the exam categories), OR order/attend the ABQAURP Core Body of Knowledge online or live course Have a professional, working knowledge of the English language

10 The Exam Process After you complete and return the exam application, our Credentialing Committee will spring into action! They will verify and evaluate your eligibility to sit for the exam. Once credentialed, the candidate will be approved and notified via the address provided to us in your application. The Renewal Process 8 hours of approved CE/CME bi-annually

11 American Nursing Credentialing Center Nursing Case Management Certification RN-BC Domains of Practice Clinical Case Management Practice Resource Management Quality Management Legal and Ethical Considerations Education

12 Nursing Case Management Certification Eligibility Criteria: Hold a current, active RN license within a state or territory of the United States or the professional, legally recognized equivalent in another country. Have practiced the equivalent of 2 years full-time as a registered nurse. Have a minimum of 2,000 hours of clinical practice in case management nursing within the last 3 years. Have completed 30 hours of continuing education in case management nursing within the last 3 years.

13 Initial Application Process There are 175 questions on the exam and 150 are scored and 25 are un-scored pilot questions This exam is a computer-based test. This means you can apply all year and test during a 90-day window at a time and location convenient to you. Applications for this certification will be accepted at any time. Test results are given before you leave the test center. Cost varies based on membership in a professional organization Range $270 - $395 USD 2012 American Nurses Credentialing Center

14 International Testing ANCC exams are available internationally. For test center locations, please visit If you plan to take the exam at any international location, please follow these instructions: If you are licensed outside the US: Please have the RN license verified for equivalency by a credentials evaluation organization, such as World Education Services (WES) or CGFNS International (CGFNS) prior to application. If you were educated outside the US and the exam requires a degree (NON-APRN only): Please have degrees verified for equivalency by a credentials evaluation organization, such as WES or CGFNS prior to application. This applies to nurses licensed inside and outside the US. If you are an APRN (Clinical Nurse Specialist and Nurse Practitioner) applicant: Candidates must meet all current eligibility requirements. This includes: hold a master's, postgraduate, or doctoral degree from program accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission in Nursing (ACEN) (formerly NLNAC National League for Nursing Accrediting Commission). ANCC does not accept individual course-by-course evaluations of programs. This applies to nurses license inside and outside the US. Contact the ANCC Customer Care Center at or or certification@ana.org for details or if you have additional questions.

15 Renewal Certification Renewal is every 5 years Contact Hours Academic Credits Presentations and Lectures Publication or Research Preceptorship Volunteer Service 2012 American Nurses Credentialing Center

16 Study Aids Study materials available Test content outline Test references Free sample test questions One day review seminar 4 week study group in the evening Review and Resource Manual Online test taking strategies

17 Commission for Case Management Certification - CCMC Board Certified Case Manager - CCM First nationally accredited case manager credential. Certification exam is based on ongoing scientific research; practicebased questions are developed by case management subject matter experts.

18 Eligibility Requirements - Candidates Must: 1. Meet licensure or certification criteria 2. Qualify within one of CCMC s employment experience categories 3. Be of good moral character, consistent with the CCMC Code of Ethics and Professional Conduct 4. Demonstrate they possess an acceptable minimum level of basic knowledge of the case management process (via the exam)

19 What is the Process? Online Application Online Exam Preliminary Immediate results $150 application fee $175 exam fee Offered 3 times a year Eligible for first test window

20 Thoughts from a CM Employer

21 UnitedHealth Group UNH Publicly Traded Registrant (NYSE) UnitedHealthcare Health Benefits Health care coverage and benefits businesses, unified under a master brand Employer and Individual Community and State Medicare and Retirement Optum Health Services Information and technology-enabled health services platform, encompassing: Technology solutions Intelligence and decision support tools Health management and interventions Administrative and financial services Pharmacy solutions Helping people live healthier lives Diverse benefits business Ensuring 38 million individuals get the best care Positioned well for post health care reform Helping to make the health care system work better for everyone Independent businesses providing services to: 6,200 hospital facilities 66,000+ pharmacies 246,000 health care professionals or groups Nearly 60 million individuals

22 Attributes of a Successful Case Manager Clinical Clinical knowledge and experience Ability to perform an assessment leading to the development of a consumer centric care plan Critical thinking and analytical skills Health Care Knowledge of the health care delivery system Benefit plans Resources including health care providers and community Communication Verbal and written communication skills Ability to influence and motivate consumers Communicate and collaborate with both internal and external providers Business Demonstrate an understanding of how case management translates into outcomes Business acumen and understanding of business basics Fundamental skills to support change management

23 Case Management: The Industry and the Future Increasing need for Case Managers who are certified in response to changes to the health care delivery system Employers need to focus on hiring the best by identify core competencies and align with hiring practices Shift focus to case management as a career path with Certified Case Managers a standard and mandate Organizations will evaluate certification options to align with business strategy and business process

24 Essential Need for Qualified Case Managers Support industry changes and requirements Develop & growth a sustainable workforce of case managers Qualified case managers provide results Delivering greater value Benefit changes and affordability Limitations in available services Accreditation requirements versus program outcomes Competencies to support business goals Serve as a resource for developing new hires Embrace the desire for continued learning Support continuous quality improvement Improvements in quality service and outcomes Maximizing the delivery of the case management process Enhance effectiveness within a multidisciplinary team Providing CM effectively and efficiently Member satisfaction and support growth Deliver on the greatest potential for a return on investment

25 Accreditation

26 Definition: Accreditation A standardized program for evaluating healthcare organizations to ensure a specified level of quality, as defined by a set of national industry standards. Organizations that meet accreditation standards receive an official authorization or approval of their services. Accreditation entails a voluntary survey process that assesses the extent of a healthcare organization's compliance with the standards for the purpose of improving the systems and processes of care (performance) and, in so doing, improving patient outcomes.

27 Accrediting Bodies URAC - NCQA ementcm.aspx

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