CMGT-BC Exam Information and Guideline
ANCC Nursing Case Management Certification
Below are complete topics detail with latest syllabus and course outline, that will help you good knowledge about exam objectives and topics that you have to prepare. These contents are covered in questions and answers pool of exam.
Certification Name: Nursing Case Management Certification (CMGT-BC)
Credential Awarded: CMGT-BC (Case Management-Board Certified)
Administered By: American Nurses Credentialing Center (ANCC)
Eligibility: Open to registered nurses (RNs) who meet specific practice and education requirements.
Exam Format: Computer-based test (CBT)
Exam Length: 3.5 hours (including 15 minutes for a tutorial and 15 minutes for a post-exam survey)
Number of Questions: 175 questions (150 scored, 25 unscored pretest questions)
Question Types: Multiple-choice questions (MCQs)
Passing Score: Scaled score system (details on passing criteria are not publicly disclosed by ANCC)
- Foundations of Case Management
- Definition and Scope of Case Management:
- Understanding the role
- responsibilities
- goals of a case manager
- Case Management Models:
- Familiarity with various models such as the Collaborative Model
- Brokerage Model, and Clinical Case Management Model
- Standards of Practice:
- Knowledge of the Case Management Society of America (CMSA) Standards of Practice and the American Nurses Association (ANA) standards.
- Ethical and Legal Considerations:
- Understanding ethical principles
- confidentiality
- informed consent
- legal issues in case management
- Regulatory and Accreditation Requirements:
- Familiarity with regulations such as HIPAA
- Medicare/Medicaid guidelines
- accreditation standards (e.g., Joint Commission)
- Care Coordination and Transitions of Care
- Care Coordination Principles:
- Strategies for coordinating care across multiple providers and settings.
- Transition Planning:
- Ensuring smooth transitions between healthcare settings
- hospital to home
- acute care to long-term care
- Discharge Planning:
- Developing and implementing effective discharge plans to prevent readmissions.
- Interdisciplinary Collaboration:
- Working with healthcare teams
- including physicians
- social workers
- therapists
- optimize patient outcomes
- Patient-Centered Care
- Patient Advocacy:
- Ensuring the patient’s voice is heard and their preferences are respected.
- Cultural Competence:
- Providing care that is sensitive to the patient’s cultural
- religious
- social background
- Health Literacy:
- Assessing and addressing the patient’s ability to understand and act on health information.
- Patient Education:
- Educating patients and families about their conditions
- treatment options
- self-care strategies
- Utilization Management
- Resource Management:
- Efficient use of healthcare resources to achieve optimal patient outcomes.
- Cost-Effective Care:
- Balancing quality care with cost containment.
- Prior Authorization and Denial Management:
- Understanding insurance requirements and managing denials or appeals.
- Evidence-Based Practice:
Using research and clinical evidence to guide decision-making.
- Quality and Outcomes Management
- Quality Improvement:
- Implementing strategies to improve healthcare quality and patient safety.
- Performance Metrics:
- Understanding key performance indicators (KPIs) such as readmission rates
- patient satisfaction scores
- length of stay.
- Outcome Measurement:
- Evaluating the effectiveness of case management interventions.
- Risk Management:
- Identifying and mitigating risks to patient safety and organizational liability.
- Healthcare Reimbursement and Financing
- Payment Models:
- Understanding fee-for-service
- value-based care
- bundled payments.
- Reimbursement Systems:
- Familiarity with Medicare
- Medicaid
- private insurance reimbursement processes.
- Cost-Benefit Analysis:
- Evaluating the financial impact of case management interventions.
- Budgeting and Financial Planning:
- Managing budgets and resources within a case management program.
- Population Health Management
- Health Promotion and Disease Prevention:
- Strategies for improving population health outcomes.
- Chronic Disease Management:
- Managing conditions such as diabetes
- heart disease
- COPD.
- Social Determinants of Health:
- Addressing factors such as housing
- education
- socioeconomic status that impact health outcomes.
- Community Resources:
- Connecting patients with community-based services and support.
- Technology in Case Management
- Health Information Systems:
- Using electronic health records (EHRs) and case management software.
- Telehealth:
- Leveraging telehealth for remote patient monitoring and consultations.
- Data Analytics:
- Using data to identify trends
- measure outcomes
- improve care delivery.
- Privacy and Security:
- Ensuring the confidentiality and security of patient information.
- Professional Practice
- Leadership and Advocacy:
- Leading case management teams and advocating for policy changes.
- Professional Development:
- Engaging in continuing education and staying current with best practices.
- Certification and Licensure:
- Understanding the requirements for maintaining CMGT-BC certification and state licensure.
- Interprofessional Collaboration:
- Building effective relationships with other healthcare professionals.
- Case Management Process:
- Assessment
- planning
- implementation
- coordination
- monitoring
- evaluation.
- Care Plan:
- A documented plan outlining the patient’s goals and interventions.
- Continuity of Care:
- Ensuring seamless care across different providers and settings.
- Determinants of Health:
- Factors that influence health outcomes
- genetics
- behavior
- environment.
- Health Equity:
- Ensuring fair and equal access to healthcare resources.
- Patient-Centered Medical Home (PCMH):
- A care delivery model focused on comprehensive
- patient-centered care.
- Value-Based Care:
- A healthcare delivery model that rewards quality and outcomes rather than volume of services.
- ANA Code of Ethics for Nurses with Interpretive Statements
- CMSA Standards of Practice for Case Management (eg, patient advocacy)
- Concepts of nursing case management
- Nursing scope and standards of practice
- Utilization management (eg, authorizations, denials and appeals)
- Benefit management (eg, payor reimbursement, cost sharing, coordination of benefits)
- Resource coordination (eg, providers, community)
- Transition of care management (eg, planning, facilitation, evaluation)
- Data management (eg, collection, analysis, benchmarking)
- Performance improvement (eg, outcome measurement and evaluation)
- Patient education (eg, readiness for change, motivational interviewing, health literacy, medication reconciliation, safety, therapeutic communication, advanced care planning)
- Population health initiatives (eg, screenings/risk stratifications, risk-reduction strategies, health equity, social drivers/determinants of health)