Inquire through: | Professional | Confidential Support
NSG 440 Exam 3 Verified and Updated
Questions and Answers (100% Correct
Answers)
case management role
Answer: management and implementation of coordination of care for INDIVIDUAL
clients. Assigned to maximize care outcomes (typically w/medicaid) for those with
LIFELONG, COMPLEX diseases
Ex: diabetes, asthma, CHF, spinal cord injury
what are primary drivers of prioritization in case management care
Answer: complexity
HIGH COST CHRONIC DISEASE
due to ___ and ___ case management is provided based on prioritization...
Answer: staffing; time constraints
case management assessment includes
Answer: Reviewing current enrollments. Case finding and eligibility determination,
completes screening and intake
BROKER (facilitator)
Answer: ensuring that required services meet insurance coverage and limits. A case
manager is doing this when validating insurance coverage.
Ex: Providing a list of local rehab facilities that take a patient's insurance
Medicaid
Answer: Federal program that provides medical benefits for low-income persons.
Medicare
Answer: A federal program of health insurance for persons 65 years of age and older
medicare also covers
Answer: certain chronic conditions and disabilities
a care plan consists of
Answer: -individual
, Inquire through: | Professional | Confidential Support
-multidisciplinary pt
life care planning is used for
Answer: CATASTROPHIC INJURY or malpractice
critical pathway and disease management protocols
Answer: management plans that display goals for patients and provide the sequence
and timing of actions necessary to achieve these goals with optimal efficiency
poor coordination of care may cause
Answer: fragmentation and duplication
advocacy
Answer: promotion of pt rights and self determination
advocacy is related to
Answer: nursing process implementation
example of advocacy
Answer: case manager involving pt in their plan of care to elicit their input
Risk Mitigation Strategies
Answer: -document interdisciplinary communication
-confirm credentials and capabilities
-referrals
-inform pt of their rights
Referrals
Answer: vetting credentials and capabilities (making sure the person will be able to
perform a procedure. will insurance cover it?)
care coordination example
Answer: a pt at the community health center experienced unnecessary repeated tests
ordered by 3 different providers
documentation is
Answer: clear and concise interdisciplinary communication
NSG 440 Exam 3 Verified and Updated
Questions and Answers (100% Correct
Answers)
case management role
Answer: management and implementation of coordination of care for INDIVIDUAL
clients. Assigned to maximize care outcomes (typically w/medicaid) for those with
LIFELONG, COMPLEX diseases
Ex: diabetes, asthma, CHF, spinal cord injury
what are primary drivers of prioritization in case management care
Answer: complexity
HIGH COST CHRONIC DISEASE
due to ___ and ___ case management is provided based on prioritization...
Answer: staffing; time constraints
case management assessment includes
Answer: Reviewing current enrollments. Case finding and eligibility determination,
completes screening and intake
BROKER (facilitator)
Answer: ensuring that required services meet insurance coverage and limits. A case
manager is doing this when validating insurance coverage.
Ex: Providing a list of local rehab facilities that take a patient's insurance
Medicaid
Answer: Federal program that provides medical benefits for low-income persons.
Medicare
Answer: A federal program of health insurance for persons 65 years of age and older
medicare also covers
Answer: certain chronic conditions and disabilities
a care plan consists of
Answer: -individual
, Inquire through: | Professional | Confidential Support
-multidisciplinary pt
life care planning is used for
Answer: CATASTROPHIC INJURY or malpractice
critical pathway and disease management protocols
Answer: management plans that display goals for patients and provide the sequence
and timing of actions necessary to achieve these goals with optimal efficiency
poor coordination of care may cause
Answer: fragmentation and duplication
advocacy
Answer: promotion of pt rights and self determination
advocacy is related to
Answer: nursing process implementation
example of advocacy
Answer: case manager involving pt in their plan of care to elicit their input
Risk Mitigation Strategies
Answer: -document interdisciplinary communication
-confirm credentials and capabilities
-referrals
-inform pt of their rights
Referrals
Answer: vetting credentials and capabilities (making sure the person will be able to
perform a procedure. will insurance cover it?)
care coordination example
Answer: a pt at the community health center experienced unnecessary repeated tests
ordered by 3 different providers
documentation is
Answer: clear and concise interdisciplinary communication
