ACM-RN study plan
ACM-RN · Give each week a clear focus.
8 weeks · About 6 hours per week
Care Management and Coordination & Transitions of Care
Map the care management and coordination process end to end, from referral through closure, and label each step with the domain-1 competency it tests
Compare case management models (for example, chronic care model versus intensive case management) and write a one-paragraph contrast of each
Identify the standardized screening and assessment instruments commonly used in care management and state what each one measures
Explain how coordination differs from advocacy and from transition planning, with a clinical example of each
Your checkpoint
A one-page process map of the care management workflow with each step annotated by the domain competency it exercises
Care Management and Coordination & Transitions of Care
Draft a care plan for a hypothetical complex patient that includes measurable goals, interventions, responsible parties, and review dates
Differentiate the case manager's roles of coordinator, navigator, and advocate in three short scenarios
Describe how interdisciplinary team meetings are structured and what the case manager contributes to them
List the warning signs of an unsafe or stalled transition and the action to take for each
Your checkpoint
A complete written care plan for one hypothetical patient, including at least five measurable goals and a transition risk assessment
Chronic and Complex Care Management & Care Management and Coordination
Outline the case management approach to the major chronic conditions (diabetes, heart failure, COPD, and hypertension), including monitoring parameters and escalation triggers
Explain how multimorbidity changes prioritization and care planning
Describe the principles of motivational interviewing and write two sample exchanges that apply them
Identify the components of a self-management support plan and how to tailor it to health literacy level
Your checkpoint
A condition-by-condition reference sheet listing monitoring parameters and escalation triggers for four chronic conditions
Chronic and Complex Care Management & Patient Advocacy and Education
Build a teaching plan for a newly diagnosed patient that accounts for readiness to learn, literacy, culture, and language
Distinguish patient education from patient counseling and from shared decision-making
Describe how to assess and document a patient's understanding using teach-back
Explain the case manager's duty when a patient declines a recommended intervention
Your checkpoint
A written patient teaching plan with a teach-back script and a documented response to a declined intervention
Psychosocial and Behavioral Health & Patient Advocacy and Education
Screen a hypothetical patient for depression, anxiety, and substance use using validated tools, and interpret the scores
Describe how to respond to disclosed intimate partner violence, suicidal ideation, and suspected elder mistreatment, including reporting obligations
Explain how social determinants (housing, food, transportation, social isolation) shape the care plan
Distinguish the case manager's scope in behavioral health from the role of the licensed behavioral health clinician
Your checkpoint
A completed psychosocial assessment for a hypothetical patient with a written response plan for each identified risk
Psychosocial and Behavioral Health & Program Evaluation, Quality, and Outcomes
Define the quality measures most relevant to case management, including readmission rate, adherence, and patient-reported outcomes
Explain how to select and interpret outcome, process, and balancing measures
Describe basic program evaluation designs and when each is appropriate
Identify how to use data to justify a change to a care management program
Your checkpoint
A one-page program evaluation outline with at least three measures, their data sources, and a proposed analysis
Legal, Ethical, and Professional Practice & Program Evaluation, Quality, and Outcomes
Apply the core ethical principles (autonomy, beneficence, nonmaleficence, justice) to three case management dilemmas
Explain confidentiality, HIPAA, and the limits of disclosure in care coordination
Describe informed consent, advance directives, and surrogate decision-making
Identify the elements of negligence and how scope of practice and documentation protect the case manager
Your checkpoint
Three written ethical dilemma analyses, each applying the four principles and reaching a documented recommendation
Care Management and Coordination & Transitions of Care & Psychosocial and Behavioral Health & Chronic and Complex Care Management & Legal, Ethical, and Professional Practice
Complete a timed full-length practice assessment and score it by domain
Review every missed item and write the underlying concept, not just the correct answer
Re-drill the two weakest domains with targeted review
Rehearse the exam-day plan, including pacing and how to approach scenario questions
Your checkpoint
A scored practice assessment with a written error log and a prioritized list of the three concepts to review last
Milestones
Week 2: Can produce a complete, measurable care plan from a case vignette without notes
Week 4: Scores at least 70% on a domain-1, domain-3, and domain-5 practice set
Week 6: Can explain, in writing, how to evaluate a case management program and which measures to use
Week 8: Scores at least 75% on the full-length practice assessment with no domain below 65%