CCM (Other exams) flashcards
CCM · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Case management process
- A collaborative sequence of intake, assessment, planning, implementation, coordination, monitoring, evaluation, and transition used to meet a member's health and service needs.
- Advocacy
- Actions taken to protect or promote a member's rights, preferences, and access to needed services, including appealing denials and resolving barriers.
- Caseload acuity
- The complexity and intensity of a member's needs, used with geography and time demands to determine equitable case manager caseloads.
- Transitional care plan
- A coordinated plan that addresses medication reconciliation, follow-up appointments, warning signs, and community support before a member moves between care settings.
- Outcome indicators
- Measures such as clinical status, functional ability, satisfaction, and cost that are tracked to determine whether case management interventions achieved intended results.
- Cultural competence
- The ability to communicate and plan care effectively while respecting a member's language, values, beliefs, and health practices.
- Resource brokerage
- Connecting a member to appropriate services and benefits, including verifying eligibility, coordinating referrals, and removing access barriers.
- Documentation standard
- Timely, objective, and specific records of assessments, interventions, member responses, and rationale that support coordination, continuity, and reimbursement.
- Autonomy
- The ethical principle that a competent member has the right to make informed decisions about care, including refusing recommended services.
- Beneficence
- The ethical principle of acting to benefit the member by promoting health, safety, and well-being through appropriate services.
- Nonmaleficence
- The ethical principle of avoiding harm and minimizing risks when coordinating care or recommending services.
- Justice
- The ethical principle requiring fair and equitable allocation of resources and treatment without discrimination.
- Informed consent elements
- Valid informed consent requires decision-making capacity, disclosure of relevant information, understanding, and voluntary choice without coercion.
- HIPAA TPO
- HIPAA permits use or disclosure of protected health information without authorization for treatment, payment, and health care operations.
- Mandatory reporting
- Legal obligations to report suspected abuse, neglect, or certain communicable diseases to designated authorities, overriding usual confidentiality.
- Professional boundaries
- Limits that keep the case manager-member relationship focused on professional goals and prevent personal, financial, or sexual exploitation.
- Medicare Parts
- Medicare Part A covers inpatient hospital and some post-acute care; Part B covers outpatient and physician services; Part C is Medicare Advantage; Part D covers drugs.
- Medicaid
- A federal-state health program for eligible low-income people that varies by state and often covers long-term services and supports.
- Managed care
- A delivery model using provider networks, care coordination, and utilization controls to manage cost, quality, and access.
- Utilization review
- A process that evaluates medical necessity and appropriateness of care before, during, or after services to guide coverage decisions.
- Levels of care
- The range of service intensity including inpatient, observation, skilled nursing, home health, outpatient, and community-based care.
- Value-based payment
- A reimbursement approach that links payment to quality, outcomes, and cost performance rather than volume alone.
- Social determinants of health
- Conditions such as income, housing, food, transportation, education, and social support that influence health outcomes and care access.
- Care continuum
- The sequence of services from prevention and acute treatment through rehabilitation, long-term care, and end-of-life care.
- Psychosocial assessment
- A structured evaluation of support, housing, finances, mental health, substance use, safety, coping, and cultural factors affecting care.
- Stages of change
- Precontemplation, contemplation, preparation, action, maintenance, and relapse are stages in the transtheoretical model that describe readiness to change a health behavior.
- Grief response
- Grief is individual and may include denial, anger, bargaining, depression, and acceptance, but these responses are not linear or universal.
- Social support types
- Emotional support provides caring; informational support provides guidance; instrumental support provides tangible aid; appraisal support provides feedback for self-evaluation.
- Crisis intervention
- Short-term intervention that prioritizes safety, stabilization, emotional support, and connection to appropriate services during an acute crisis.
- PHQ-9
- A nine-item depression screening tool that scores symptom severity; a positive screen requires clinical follow-up and suicide risk assessment.
- Harm reduction
- Practices that reduce risks associated with substance use, such as overdose prevention and safer use, without requiring abstinence as a precondition.
- Family systems
- A framework viewing the family as an interdependent system in which illness affects roles, communication, caregiving, and coping across members.