This comprehensive resource covers all six CCM exam domains while connecting theory to actual case management practice through detailed patient cases that demonstrate how concepts apply in complex healthcare situations.

Five Comprehensive Clinical Scenarios

This study guide features five in-depth clinical scenarios that bring case management concepts to life

Each scenario includes detailed patient profiles, comprehensive assessments, intervention planning, challenges encountered, problem-solving approaches, outcomes achieved, and teaching points connecting to examination content. These scenarios develop the clinical reasoning and practical judgment that distinguish excellent case managers.

Complete Domain Coverage

This study guide addresses every area tested on the CCM examination with content proportional to actual exam weighting:

Care Delivery and Reimbursement Methods: Medicare Parts A, B, C, and D coverage and eligibility. Medicaid and dual-eligible populations. Managed care models and utilization management. Post-acute care settings including skilled nursing facilities, inpatient rehabilitation, long-term acute care, and home health. Payment methodologies including DRGs, capitation, and bundled payments. Workers' compensation systems. Prior authorization and appeals processes. Value-based care and accountable care organizations.

Psychosocial Concepts and Support Systems: Comprehensive psychosocial assessment approaches. Validated screening tools for depression, anxiety, substance use, and caregiver burden. Cultural competency and health literacy. Social determinants of health including housing, food security, and transportation. Motivational interviewing techniques. Stages of change model application. Grief, loss, and adjustment to illness. Trauma-informed care principles. Building social support and community connections.

Quality Outcomes Evaluation and Measurement: Donabedian model of structure, process, and outcome. Quality improvement methodologies including PDSA, Lean, and Six Sigma. Risk stratification and predictive modeling. HEDIS measures and CAHPS surveys. Accreditation standards from URAC, NCQA, and Joint Commission. Root cause analysis and failure mode effects analysis. Patient safety culture and high-reliability organizations. Evidence-based practice integration. Care transitions quality measurement.

Rehabilitation Concepts and Strategies: Functional assessment using FIM, Barthel Index, and Lawton IADL scales. Rehabilitation team composition and roles. Physical therapy, occupational therapy, and speech-language pathology scopes. Vocational rehabilitation and return-to-work planning. Functional capacity evaluations. ADA requirements and reasonable accommodations. Chronic disease self-management programs. Assistive technology and environmental modifications. Work hardening and transitional duty programs.

Ethical and Legal Practice Standards: Core ethical principles including autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity. HIPAA Privacy and Security Rules. Informed consent requirements. Advance directives including living wills, healthcare proxies, and POLST forms. Scope of practice boundaries. Mandatory reporting obligations. Professional boundaries and conflicts of interest. Documentation standards and legal considerations.

Case Management Principles and Processes: Case management process from identification through evaluation. Comprehensive assessment methodologies. Care plan development with SMART goals. Care coordination across settings and providers. Discharge planning and transitions of care. Medication reconciliation practices. Patient engagement and activation strategies. Interdisciplinary collaboration and communication. Telephonic and field-based case management models. Disease management and population health approaches.

Carepoint Publishing

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