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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 patients voice is heard and their preferences are respected.
- Cultural Competence:
- Providing care that is sensitive to the patients cultural
- religious
- social background
- Health Literacy:
- Assessing and addressing the patients 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 patients 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)