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Nurse case manager test Exam Questions and Correct Answers $13.99   Add to cart

Exam (elaborations)

Nurse case manager test Exam Questions and Correct Answers

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  • Course
  • Nurse case manager
  • Institution
  • Nurse Case Manager

Nurse case manager test Exam Questions and Correct Answers (TPA)y Thirdy partyy administratory-y CORRECTy ANSWER Organizationy thaty processesy healthy claimsy andy othery businessy relatedy functionsy ofy healthy plan 3y typesy ofy m...

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  • October 14, 2024
  • 8
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • Nurse case manager
  • Nurse case manager
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TIFFACADEMICS
Nurse case manager test Exam
Questions and Correct Answers


(TPA)yThirdypartyyadministratory-yCORRECTyANSWER-
Organizationythatyprocessesyhealthyclaimsyandyotherybusinessyrelatedyfunctionsyofyhealthy
plan

3ytypesyofymeasurementsyofyperformanceyimprovementy-yCORRECTyANSWER-
1)yprocess
2)ystructure
3)youtcome

4ycomponentsyofyinterpersonalycommunicationy-yCORRECTyANSWER-sender
message
receiver
context

5ybasisyethicalyprinciplesy-yCORRECTyANSWER-Beneficence
Non-malfeasance
autonomy
justicey
fidelity

5ystagesyofychangey-yCORRECTyANSWER-1.yPrecontemplation
2.yContemplation
3.yPreparation
4.yAction
5.yMaintenance

Accreditationy-yCORRECTyANSWER-
entailsyvoluntaryysurveyyprocessythatyassessesytheyextentyofyayhealthcareyorganization'syc
omplianceywithytheystandardsytoyimproveypatientyoutcomes

ADAy-yAmericanyDisabilitiesyActydefinesyaydisabilityy-yCORRECTyANSWER-
1)yhasyayphysicalyorymentalyimpairmentythatylimitsyaymajorylifeyactivity
2)yhasyayrecordyoryhistoryyofyaysubstantiallyylimitingyimpairment
3)yisyregardedybyyERyasyhavingyaysubstantiallyylimitingyimpairment
4)yalsoyprotectsypriorydrugyaddictionyifytheyyhaveybeenyrehab'd.

Beneficencey-yCORRECTyANSWER-toydoygood

, CAGEytooly-yCORRECTyANSWER-cutydown,yannoyed,yguilty,yeyeyopener

Capitationy-yCORRECTyANSWER-Ayfixedyamountyofymoneyyper-member-per-
monthy(PMPM)ypaidytoyaycareyprovideryforycoveredyservicesyratherythanybasedyonyspecificy
servicesyprovided.yTheytypicalyreimbursementymethodyusedybyyHMOs.yWhetheryaymember
yusesytheyhealthyserviceyonceyorymoreythanyonce,yayproviderywho

isycapitatedyreceivesytheysameypayment

CARFy-yCommissionyonyAccreditationyofyRehabilitationyFacilitiesy-yCORRECTyANSWER-
Private,ynon-
profityestablishesystandardsyofyqualityyforyservicesytoypeopleyw/ydisabilities.yOffersyvoluntar
yyaccreditationytoyrehabyfacilities

CarveyOuty-yCORRECTyANSWER-
Servicesyexcludedyfromyayproviderycontractythatymayybeycoveredythroughyarrangementsywi
thyotheryproviders.yProvidersyareynotyfinanciallyyresponsibleyforyservicesycarvedyoutyofytheiry
contract.

Caseymanagementyprocess:y-yCORRECTyANSWER-Screening
Assessing
Stratifyingyrisk
planning
implementing
followingyup
transitioningy
communication
evaluation

COBy-yCoordinationyofyBenefitsy-yCORRECTyANSWER-
ayprogramyforydeterminingywhichyhealthyinsurerypaysyforyservicesyfirstywhenyaybeneficiaryyis
ycoveredybyymoreythanyoneyhealthycareyplan.yPrimaryyorysecondaryyinsuracne




Concurrentyreviewy-yCORRECTyANSWER-
reviewyforymedicalynecessityyofytestsyandyproceduresyorderedyduringyanyinpatientyhospitali
zation.yAnotheryformyofyURythatytracksyconsumptionyofyresourcesywhileyIEyisyhospitalized

Conflictyresolutionystrategiesy-yCORRECTyANSWER-1)collaboration
2)ynegotiation
3)yaccommodation
4)ycompetitive
5)yavoidance

continuedystayyreviewy-yCORRECTyANSWER-
usedytoydetermineythatyeachydayyofytheyhospitalystayyisynecessaryyandythatycareyisybeingyre
nderedyatytheyappropriateylevel.yItytakesyplaceyduringyaypatient'syhospitalizationyforycare.

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