CCM Exam Prep 8-Week Study Plan

Week 1 — Part I: Case Management Process and Tools

Difficulty: Heavy

What it covers:

• The definition, philosophy, and guiding principles of case management

• The 8 Essential Activities of the case manager applied across the care continuum

• Screening, case identification, and triage to determine who benefits from case management

• The comprehensive biopsychosocial assessment and risk stratification

• The Individualized Care Plan, SMART goal-setting, and interdisciplinary co-creation

• Implementation, monitoring, and case closure criteria

• Practice settings across acute, post-acute, community, payer, and workers' compensation environments

• Documentation, informatics, and health IT standards that protect privacy and continuity of care

Print: 1 Mind Map, 3 Comparison Charts, 2 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first — complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read — follow the Made Easy Highlighting System exactly:

• Blue: Process & Workflow (The Case Manager's Playbook)

• Red: Laws, Ethics & Compliance (Don't Cross These Lines)

• Green: Reimbursement & Payer Systems (Follow the Money)

• Purple: Named Models, Tools & Frameworks (The "Acronym Army")

• Yellow: Psychosocial & Patient Factors (The Human Side)

• Orange: Quality, Outcomes & Measurement (Did It Work?)

☐ Lock in the 8 Essential Activities before anything else in this book. The entire CCM exam is structured around what the case manager actually does, in what order, and why. Be able to name all 8 from memory and walk through each one for a sample client — what triggers it, what tools support it, and what documentation it produces. Every clinical scenario question on the CCM traces back to one of these activities.

☐ Master the screening → case identification → triage sequence. Screening identifies candidates for case management; case identification confirms appropriateness against admission criteria; triage prioritizes intensity of intervention. Know the high-risk indicators that move a client to the top of the triage list — frequent admissions, polypharmacy, multiple comorbidities, behavioral health overlay, social determinants of health risk, and recent transitions of care.

☐ Practice writing SMART goals until they are automatic. Specific, Measurable, Achievable, Relevant, Time-bound — and co-created with the client. The CCM tests poorly written goals as distractors; you will be asked to identify the goal that violates one of the five elements. Build 5–10 SMART goals across different scenarios (CHF, post-stroke, complex pediatric, workers' comp injury, cancer survivorship) before moving on.

☐ Build a clean one-page reference for practice settings. Acute care, post-acute (SNF, IRF, LTACH, home health, hospice), community-based, payer-based (telephonic and in-person), and workers' compensation each have distinct workflows, dominant payment models, and documentation requirements. Know which assessment tools and care plan templates fit each setting.

☐ Complete the Practice Questions for Part I in your quiz bank. Review every rationale — correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Case Management Process & Tools. Main branches: Definition, Philosophy & Standards of Practice → 8 Essential Activities → Screening, Case Identification & Triage → Biopsychosocial Assessment & Risk Stratification → Individualized Care Plan & SMART Goals → Implementation, Monitoring & Case Closure → Practice Settings (acute, post-acute, community, payer, workers' comp) → Documentation, Informatics & Health IT.

Comparison Charts:

☐ Chart 1 — Screening vs. Case Identification vs. Triage: Purpose, what triggers each step, criteria applied, tools used, who performs it, and what the output is (referral, enrollment, intensity tier).

☐ Chart 2 — Acute vs. Post-Acute vs. Community vs. Payer-Based vs. Workers' Comp Case Management: Setting characteristics, typical caseload, dominant payment model, primary assessment tool, and the case manager's day-to-day priorities in each.

☐ Chart 3 — SMART Goal vs. Non-SMART Goal: Each element (Specific, Measurable, Achievable, Relevant, Time-bound) shown with a violating example, a fix, and the consequence of leaving the violation in the care plan.

Cornell Notes:

☐ Page 1 — Cue questions: What are the 8 Essential Activities of the case manager, and in what order do they typically unfold across a case? What is the difference between screening, case identification, and triage, and what high-risk indicators move a client to the top of the triage list?

☐ Page 2 — Cue questions: What are the five elements of a SMART goal, and what is the most common error case managers make when writing each one? What are the core components of a comprehensive biopsychosocial assessment, and how does each domain feed into the Individualized Care Plan?

Week 2 — Part II: Care Coordination, Transitions, and Engagement

Difficulty: Heavy — High Yield

What it covers:

• Care coordination and the case manager's role within an interdisciplinary team

• The major transitions-of-care models: CTI (Coleman), Project BOOST, TCM (Naylor), and Project RED

• Discharge planning and post-acute placement decisions based on clinical and functional criteria

• Advocacy and negotiation skills for securing services and influencing payer and provider decisions

• Health literacy assessment and patient education using teach-back, plain language, and culturally responsive methods

• Motivational interviewing — evoking change talk, working with ambivalence, supporting sustainable behavior change

• Telehealth, remote monitoring, and digital health tools integrated into the care plan with attention to privacy and equity

Print: 1 Mind Map, 4 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first — complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read — follow the Made Easy Highlighting System 

☐ The four transitions-of-care models are tested directly and repeatedly — know them cold. CTI (Care Transitions Intervention, Coleman) emphasizes coaching the patient and caregiver through four pillars: medication self-management, dynamic patient-centered record, follow-up, and red flags. Project BOOST (Better Outcomes by Optimizing Safe Transitions) is hospital-based and uses the 8P risk assessment tool. TCM (Transitional Care Model, Naylor) uses an advanced practice nurse following the patient from hospital to home over multiple weeks for high-risk older adults. Project RED (Re-Engineered Discharge) is a hospital-based 12-component discharge bundle including the After Hospital Care Plan. Be able to match each model to its target population, setting, and intervention intensity.

☐ Build a clean post-acute placement reference. Each level of care has admission criteria you must defend in documentation: IRF requires 3 hours/day of therapy tolerance and reasonable expectation of significant improvement; LTACH requires medically complex needs and an expected stay over 25 days; SNF requires daily skilled need but lower therapy intensity than IRF; home health requires homebound status and a skilled need. Wrong-level placement is one of the most common rationale-based exam scenarios.

☐ Motivational interviewing is a Purple topic — it is a named, structured method. The four processes are Engaging, Focusing, Evoking, and Planning. The core skills are OARS — Open questions, Affirmations, Reflective listening, Summaries. The goal is to evoke the client's own change talk rather than persuade. Know the difference between sustain talk (reasons to stay the same) and change talk (reasons to change), and how a case manager responds to each without arguing.

☐ Health literacy assessment uses several validated tools — REALM, TOFHLA, NVS — but the universal precaution approach is to use plain language and teach-back with every client. Teach-back is the gold-standard verification: "In your own words, tell me what we just decided you'll do when you get home." If the client cannot teach it back, you re-teach in a different way — you do not move on.

☐ Complete the Practice Questions for Part II in your quiz bank. Review every rationale — correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Care Coordination, Transitions & Engagement. Main branches: Care Coordination & the Interdisciplinary Team → Handoff & Communication (SBAR, warm handoff) → Transitions-of-Care Models (CTI, BOOST, TCM, RED) → Discharge Planning & Post-Acute Placement (IRF, LTACH, SNF, home health, hospice) → Advocacy & Negotiation → Health Literacy & Patient Education (teach-back, plain language) → Motivational Interviewing (Engaging, Focusing, Evoking, Planning; OARS) → Telehealth, Remote Monitoring & Digital Health.

Comparison Charts:

☐ Chart 1 — CTI vs. BOOST vs. TCM vs. RED: Target population, setting, lead clinician type, intervention duration, signature tool or framework (Four Pillars, 8P, APN visits, AHCP), and best clinical scenario for each.

☐ Chart 2 — IRF vs. LTACH vs. SNF vs. Home Health vs. Hospice: Admission criteria, therapy intensity, typical length of stay, dominant payer/payment model, and one disqualifying condition for each.

☐ Chart 3 — Change Talk vs. Sustain Talk (Motivational Interviewing): Definition, client language examples, case manager response, what to avoid (the "righting reflex"), and how to move ambivalence forward without confrontation.

☐ Chart 4 — Teach-Back vs. Show-Me vs. Read-Back: When each verification method is used, what literacy or skill it confirms, and how the case manager responds when the client cannot complete the verification successfully.

Cornell Notes:

☐ Page 1 — Cue questions: What are the four major transitions-of-care models, and what is the signature tool, target population, and setting for each? What four pillars define the Coleman Care Transitions Intervention?

☐ Page 2 — Cue questions: What are the admission criteria for IRF, LTACH, SNF, and home health, and what is one common documentation error that gets a client placed at the wrong level? What is the difference between discharge planning and transitional care management?

☐ Page 3 — Cue questions: What are the four processes of motivational interviewing, and what does OARS stand for? How do you respond to sustain talk versus change talk without triggering the righting reflex? What is the teach-back method, and what is the correct case manager response when the client cannot teach the plan back?

Week 3 — Part III: Reimbursement Concepts and Strategies

Difficulty: Heavy — High Yield

What it covers:

• Medicare Parts A, B, C, and D — what each covers, who administers it, and how it is funded

• Medicaid, CHIP, and dual-eligibility — how state and federal roles interact

• Commercial managed care models: HMO, PPO, EPO, POS — and the implications for client access and choice

• Fully insured plans versus self-insured plans, and how ERISA preempts state law for self-insured benefits and appeals

• Reimbursement methodologies — DRG, RBRVS, capitation, and bundled payment

• Utilization review, prior authorization, evidence-based criteria, and medical necessity documentation

• The appeals process across commercial, Medicare, and Medicaid pathways, including escalation criteria

Print: 1 Mind Map, 4 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first — complete the High-Yield Objectives, Key Terms and 

Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read — follow the Made Easy Highlighting System 

☐ Lock in Medicare A, B, C, D before anything else. Part A: hospital, SNF (limited), home health, hospice — funded by FICA payroll tax, no premium for most beneficiaries. Part B: outpatient, physician services, DME — funded by general revenues and beneficiary premiums. Part C (Medicare Advantage): private managed care plans that bundle A and B (and usually D) — funded by Medicare paying the plan a capitated rate. Part D: outpatient prescription drugs — private plans, beneficiary premiums and government subsidies. Every Medicare coverage question on the CCM tests one of these four buckets — knowing which part covers a specific service is the most preventable error on the exam.

☐ Medicaid versus Medicare is one of the most-tested distinctions on the CCM. Medicare is federal, age- or disability-based, and largely uniform. Medicaid is jointly state and federally funded, income- and asset-based, and varies dramatically by state. Dual-eligibles ("dual eligibles" or "Medi-Medi") qualify for both — Medicare is primary, Medicaid is secondary and often covers what Medicare does not (long-term care, dental, transportation, cost-sharing). Know the five Medicaid eligibility pathways and the special rules for institutional Medicaid and home- and community-based services (HCBS) waivers.

☐ The four commercial managed care models trade off cost, choice, and gatekeeping. HMO: requires PCP gatekeeper, in-network only, lowest cost, no out-of-network coverage except emergencies. PPO: no PCP required, in- and out-of-network coverage, higher cost, broadest choice. EPO: no PCP required but in-network only, mid-range cost. POS: requires PCP gatekeeper but allows out-of-network with referral, mid-range cost. Be able to match a client scenario (snowbird who travels, single PCP relationship, frequent specialist user) to the right plan.

☐ ERISA is a high-yield Red and Green topic. Self-insured employer plans are governed by ERISA, which preempts most state insurance laws and runs appeals under federal rules (initial denial, internal appeal, external review under the ACA, federal court). Fully insured plans are governed by state insurance law and use the state's appeal process and Department of Insurance. Knowing whether a plan is fully insured or self-insured determines which appeal pathway you use — this is a common scenario distractor.

☐ Reimbursement methodologies — DRG, RBRVS, capitation, bundled payment — each create different incentives. DRG (inpatient prospective payment, used by Medicare Part A): fixed payment per diagnosis-related group, regardless of actual length of stay or resources used — incentive is to minimize LOS. RBRVS: relative value units assigned to physician services and multiplied by a conversion factor — incentive is volume. Capitation: per-member-per-month flat payment regardless of utilization — incentive is to keep members healthy and minimize unnecessary services. Bundled payment: single payment for an episode of care across providers — incentive is coordination. Match each methodology to the case manager's role in cost containment.

☐ Complete the Practice Questions for Part III in your quiz bank. Review every rationale — correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Reimbursement Concepts & Strategies. Main branches: Medicare (Parts A, B, C, D) → Medicaid, CHIP & Dual-Eligibility → Commercial Managed Care (HMO, PPO, EPO, POS) → Fully Insured vs. Self-Insured & ERISA → Reimbursement Methodologies (DRG, RBRVS, Capitation, Bundled) → Cost-Sharing (premium, deductible, coinsurance, copay, MOOP) → Utilization Review & Prior Authorization → Appeals Process (commercial, Medicare, Medicaid).

Comparison Charts:

☐ Chart 1 — Medicare Part A vs. Part B vs. Part C vs. Part D: Services covered, administrator, funding source, beneficiary cost-sharing, and one common gap or limitation in each.

☐ Chart 2 — HMO vs. PPO vs. EPO vs. POS: PCP/gatekeeper requirement, in-network vs. out-of-network coverage, referral requirement, typical cost level, and best client scenario for each.

☐ Chart 3 — Fully Insured vs. Self-Insured (ERISA) Plans: Governing law (state vs. federal), regulator, appeals pathway, external review process, and which type of plan a large national employer typically uses.

☐ Chart 4 — DRG vs. RBRVS vs. Capitation vs. Bundled Payment: Unit of payment, who bears financial risk, dominant clinical incentive, typical setting of use, and the case manager's primary cost-containment lever under each.

Cornell Notes:

☐ Page 1 — Cue questions: What does each Medicare Part (A, B, C, D) cover, and how is each funded? Who is eligible for dual-eligibility status, and how do Medicare and Medicaid coordinate as primary and secondary payers?

☐ Page 2 — Cue questions: What are the four commercial managed care models, and how do they differ in PCP requirement, network restriction, and cost? Why does it matter whether a client's plan is fully insured or self-insured when filing an appeal?

☐ Page 3 — Cue questions: What are the four major reimbursement methodologies, and what financial incentive does each create for the provider? What are the standard steps in a commercial appeal, and at what point does external review apply under the ACA?

Week 4 — Part IV: Psychosocial Concepts and Support Systems

Difficulty: Heavy

What it covers:

• Common mental health conditions in case management — MDD, GAD, PTSD, bipolar, schizophrenia — and appropriate screening tools and referral pathways

• Substance use disorder screening with evidence-based tools and connection to harm reduction, MOUD, and recovery resources

• Crisis intervention and suicide risk assessment, including collaborative safety planning and lethal means safety counseling

• Family caregiver assessment and support, addressing caregiver burden through respite, education, and resource referral

• Cultural humility, language access standards, and culturally responsive care planning

• Social determinants of health screening and closed-loop referrals to community partners

• Spiritual assessment, advance care planning, and bereavement support across the continuum, including hospice and palliative care

• Health behavior theories — especially the Transtheoretical Model (Stages of Change) — applied to sustainable behavior change

Print: 1 Mind Map, 4 Comparison Charts, 3 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first — complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read — follow the Made Easy Highlighting System 

☐ Memorize the major mental health and substance use screening tools cold — these are tested directly. PHQ-9 for depression (cutoff scores for mild/moderate/moderately severe/severe, and the suicidality item 9). GAD-7 for anxiety. PC-PTSD-5 and PCL-5 for PTSD. AUDIT and AUDIT-C for alcohol use. DAST-10 for drug use. CAGE for problem drinking (older but still tested). SBIRT (Screening, Brief Intervention, Referral to Treatment) as the umbrella process. Know what each instrument screens for, the scoring range, the action threshold, and what comes next.

☐ Suicide risk assessment is a Red and Yellow topic — both psychosocial and legal/safety. Know the Columbia Suicide Severity Rating Scale (C-SSRS) — ideation severity, ideation intensity, suicidal behavior, and lethality. The case manager's response sequence: assess, validate, develop a collaborative safety plan (Stanley-Brown is the named framework), counsel on lethal means safety (firearms, medications), connect to crisis resources (988 Suicide and Crisis Lifeline), and document everything. The wrong intervention at the wrong risk level is a frequent exam distractor.

☐ The Transtheoretical Model (Stages of Change) is a Purple high-yield topic and the most commonly tested behavior change framework on the CCM. The five stages: Precontemplation (not considering change), Contemplation (considering, ambivalent), Preparation (planning), Action (actively changing within 6 months), Maintenance (sustained change beyond 6 months). Relapse is a normal stage, not a failure. Each stage has a different appropriate intervention — providing information in Precontemplation, exploring ambivalence in Contemplation, building a plan in Preparation, reinforcing self-efficacy in Action, and relapse prevention in Maintenance. Matching intervention to stage is a frequent scenario question.

☐ Social Determinants of Health are tested both as a concept and as specific screening tools. The major SDOH domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. Validated screening tools include PRAPARE, AHC-HRSN, and Health Leads. The case manager's job is closed-loop referral — the referral is not complete until you confirm the client connected with the resource and received the service.

☐ Caregiver assessment and burden are tested in scenario form. The Zarit Burden Interview is the most-cited named tool. Know the warning signs of caregiver burden (sleep disruption, social isolation, depression, neglect of own health, financial strain) and the interventions that work — respite care, support groups, education, and connection to Area Agencies on Aging and other community resources.

☐ Complete the Practice Questions for Part IV in your quiz bank. Review every rationale — correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Psychosocial Concepts & Support Systems. Main branches: Mental Health Conditions & Screening (PHQ-9, GAD-7, PC-PTSD-5) → Substance Use Disorders & SBIRT (AUDIT, DAST-10, MOUD) → Crisis Intervention & Suicide Risk Assessment (C-SSRS, Stanley-Brown, 988) → Caregiver Assessment & Burden (Zarit) → Cultural Humility & Language Access → Social Determinants of Health (PRAPARE, closed-loop referral) → Advance Care Planning, Hospice & Palliative Care, Bereavement → Transtheoretical Model & Health Behavior Theories.

Comparison Charts:

☐ Chart 1 — PHQ-9 vs. GAD-7 vs. PC-PTSD-5 vs. AUDIT vs. DAST-10: What each screens for, scoring range, action threshold, and the next case management step when the threshold is exceeded.

☐ Chart 2 — Stages of Change (Transtheoretical Model): Definition of each stage (Precontemplation, Contemplation, Preparation, Action, Maintenance, Relapse), client language that signals the stage, and the case manager's appropriate intervention for each.

☐ Chart 3 — Hospice vs. Palliative Care: Eligibility criteria, prognosis requirement, location of service, payer coverage (Medicare hospice benefit vs. standard medical benefit), curative treatment status, and the case manager's role in transitioning a client between the two.

☐ Chart 4 — Cultural Competence vs. Cultural Humility: Definition, mindset (mastery vs. lifelong learning), assessment of self vs. of the other, response to cultural differences, and the practical case management behaviors associated with each.

Cornell Notes:

☐ Page 1 — Cue questions: What are the major mental health and substance use screening tools used in case management, and what is the action threshold for each? What is the SBIRT process, and where does the case manager intervene at each step?

☐ Page 2 — Cue questions: What are the components of a suicide risk assessment using C-SSRS, and what is the case manager's response sequence when a client screens positive for suicidal ideation with a plan? What is lethal means safety counseling, and what are the highest-priority means to address?

☐ Page 3 — Cue questions: What are the five stages of the Transtheoretical Model, and what is the appropriate case manager intervention at each stage? What are the major domains of Social Determinants of Health, and what is the difference between a referral and a closed-loop referral?

Week 5 — Part V: Quality and Outcomes Evaluation and Measurements

Difficulty: Moderate–Heavy

What it covers:

• The Donabedian framework — structure, process, and outcome measures — applied to case management programs

• The major accreditation bodies: URAC, NCQA, and The Joint Commission, and what each accredits

• Cost-benefit analysis and return-on-investment calculation for case management interventions

• Data collection, benchmarking, and reporting principles that demonstrate program value to stakeholders

• The three continuous quality improvement models — PDSA, Six Sigma, and Lean — and when to apply each

• Patient satisfaction versus patient experience, including CAHPS, HCAHPS, and similar instruments

• Evidence-based practice and clinical practice guidelines using PICOT and the levels-of-evidence hierarchy

Print: 1 Mind Map, 3 Comparison Charts, 2 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first — complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read — follow the Made Easy Highlighting System

☐ Donabedian is the foundational framework — know it cold. Structure measures describe the setting in which care is delivered (staffing ratios, accreditation status, equipment availability, EHR adoption). Process measures describe what is done in delivering care (screenings completed, medications reconciled, follow-up calls placed within 48 hours of discharge). Outcome measures describe the result of care on the client (30-day readmission rate, A1c control, mortality, functional status improvement). Balancing measures detect unintended consequences. Be able to classify a sample list of 10 measures correctly — this is one of the most commonly tested skills on the CCM.

☐ The three accreditation bodies are an Orange and Purple high-yield topic. URAC accredits health plans, case management programs, utilization management, and specialty pharmacy. NCQA accredits health plans (HEDIS measures are NCQA's) and also accredits case management. The Joint Commission accredits hospitals, behavioral health organizations, home care, and ambulatory care. Know which body accredits which type of organization — the CCM tests this directly.

☐ PDSA versus Six Sigma versus Lean is a frequent comparison question. PDSA (Plan-Do-Study-Act) is a rapid-cycle improvement method best for small tests of change. Six Sigma uses DMAIC (Define, Measure, Analyze, Improve, Control) and is best for reducing variation and defects in well-defined processes — the goal is 3.4 defects per million opportunities. Lean focuses on eliminating waste (the 8 wastes — defects, overproduction, waiting, non-utilized talent, transportation, inventory, motion, extra-processing) and improving flow. Match each method to a scenario: small experiment → PDSA; reducing readmission variation across hospitals → Six Sigma; streamlining discharge workflow → Lean.

☐ CAHPS versus HCAHPS — both are patient survey instruments but they measure different things and are tested as a distinction. CAHPS is the umbrella family of patient experience surveys covering many settings (health plans, home health, hospice, clinician and group). HCAHPS is the specific hospital version, publicly reported, and tied to Medicare value-based purchasing. Patient experience measures what happened (communication, responsiveness, cleanliness, discharge information). Patient satisfaction measures whether the client liked what happened. The two are related but not the same — CCM exam scenarios will test the distinction.

☐ PICOT is the named framework for building an evidence-based practice question — Population, Intervention, Comparison, Outcome, Time. Be able to construct a PICOT question for a case management scenario. Then map evidence to the levels-of-evidence hierarchy: Level I (systematic reviews and meta-analyses of RCTs) is strongest; Level VII (expert opinion) is weakest. Know the order and what study designs sit at each level.

☐ Complete the Practice Questions for Part V in your quiz bank. Review every rationale — correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Quality & Outcomes Evaluation. Main branches: Donabedian Framework (Structure, Process, Outcome, Balancing) → Accreditation Bodies (URAC, NCQA, TJC) → Cost-Benefit Analysis & ROI → Data Collection, Benchmarking & Reporting → Continuous Quality Improvement (PDSA, Six Sigma DMAIC, Lean) → Patient Satisfaction vs. Patient Experience (CAHPS, HCAHPS) → Evidence-Based Practice (PICOT, Levels of Evidence, Clinical Practice Guidelines).

Comparison Charts:

☐ Chart 1 — Structure vs. Process vs. Outcome vs. Balancing Measures: Definition, what each describes about a case management program, three examples of each, and where each appears on a stakeholder dashboard.

☐ Chart 2 — URAC vs. NCQA vs. The Joint Commission: What kind of organizations each accredits, signature programs and measure sets (HEDIS, ORYX), case management accreditation status, and a representative use case where you would direct a client or employer to each.

☐ Chart 3 — PDSA vs. Six Sigma vs. Lean: Core methodology (PDSA cycle, DMAIC, waste elimination), best problem type to apply each to, signature tools (run chart, control chart, value stream map), and a sample case management improvement scenario for each.

Cornell Notes:

☐ Page 1 — Cue questions: What are the four categories of measure in the Donabedian framework, and how do you classify a given metric? Which accreditation body accredits which type of organization, and what is the signature measure set or program for each?

☐ Page 2 — Cue questions: What are the three continuous quality improvement methods, and what kind of problem is each best suited to solve? What is the difference between patient satisfaction and patient experience, and which Medicare program uses HCAHPS for value-based purchasing? What does PICOT stand for, and what are the seven levels of the evidence hierarchy?

Week 6 — Part VI: Rehabilitation Concepts and Strategies

Difficulty: Moderate

What it covers:

• The major rehabilitation settings and levels of care, and matching the right level to the client's clinical, functional, and goal-of-care profile

• Standard functional assessment tools — FIM, Barthel, Katz, and Lawton — measuring ADLs and IADLs

• Disability management and return-to-work planning using stay-at-work and return-to-work strategies, transitional duty, and disability income programs

• Vocational rehabilitation and workers' compensation — including maximum medical improvement, impairment ratings, and the role of state vocational rehab agencies

• Assistive technology and adaptive equipment — assessment, procurement, training, and follow-up

• Chronic disease management and self-management support using evidence-based programs such as CDSMP and condition-specific DSME

Print: 1 Mind Map, 3 Comparison Charts, 2 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first — complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read — follow the Made Easy Highlighting System 

Orange: Quality, Outcomes & Measurement

☐ The four functional assessment tools are a Purple high-yield topic and a frequent comparison question. FIM (Functional Independence Measure): 18 items across 6 domains, 7-point scale, used in IRF settings and reported to UDSMR — the standard for inpatient rehab outcome measurement. Barthel Index: 10 ADL items, 0–100 scale, used in stroke and general rehab. Katz Index: 6 basic ADLs (bathing, dressing, toileting, transferring, continence, feeding) — a quick screen used in geriatric assessment. Lawton IADL Scale: 8 instrumental activities (telephone, shopping, food prep, housekeeping, laundry, transportation, medication, finances) — measures community-living capacity. Know which tool to choose for which clinical question.

☐ ADLs versus IADLs is a distinction tested directly. ADLs are the basic self-care tasks needed to live (bathing, dressing, toileting, transferring, continence, feeding). IADLs are the more complex tasks needed to live independently (managing medications, managing finances, shopping, cooking, housekeeping, transportation, using the telephone, laundry). A client can lose IADLs and remain at home with support; loss of ADLs usually drives a higher level of care.

☐ Workers' compensation has its own vocabulary and process — this is heavily tested for case managers practicing in the workers' comp setting. Know the difference between temporary total disability (TTD), temporary partial disability (TPD), permanent partial disability (PPD), and permanent total disability (PTD). Maximum medical improvement (MMI) is the point at which the injured worker's condition is not expected to improve further with additional treatment — at MMI, the case shifts from medical management to impairment rating and case closure. Impairment rating is done using the AMA Guides to the Evaluation of Permanent Impairment. The 24-Hour Rule and the role of nurse case managers in jurisdiction-specific workers' comp programs are also commonly tested.

☐ Disability management is a process — stay-at-work strategies prevent absence from happening; return-to-work strategies bring the worker back after absence. Transitional duty (modified or light duty) is the bridge — temporarily modified job duties that match the worker's current functional capacity. The earlier the case manager intervenes, the better the outcome — the longer a worker is out, the lower the probability of return.

☐ Chronic Disease Self-Management Program (CDSMP) is a Stanford-developed, peer-led, evidence-based program for clients with chronic conditions. Diabetes Self-Management Education (DSME) is the diabetes-specific evidence-based program. Both build self-efficacy as the primary mechanism of change. Know who refers, who pays, and what outcomes are documented.

☐ Complete the Practice Questions for Part VI in your quiz bank. Review every rationale — correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Rehabilitation Concepts & Strategies. Main branches: Rehabilitation Settings & Levels of Care (IRF, SNF, outpatient rehab, home-based therapy) → Functional Assessment Tools (FIM, Barthel, Katz, Lawton) → ADLs vs. IADLs → Disability Management (stay-at-work, return-to-work, transitional duty) → Workers' Compensation (TTD/TPD/PPD/PTD, MMI, impairment rating, AMA Guides) → Vocational Rehabilitation → Assistive Technology & Adaptive Equipment → Chronic Disease Management (CDSMP, condition-specific DSME).

Comparison Charts:

☐ Chart 1 — FIM vs. Barthel vs. Katz vs. Lawton: What each measures (ADL vs. IADL), number of items, scoring range, primary setting of use, and the best clinical question each tool answers.

☐ Chart 2 — TTD vs. TPD vs. PPD vs. PTD (Workers' Compensation Disability Categories): Definition, who qualifies, typical benefit duration, and the case manager's role at each disability category.

☐ Chart 3 — Stay-at-Work vs. Return-to-Work vs. Transitional Duty: When each intervention is appropriate, who is involved (employer, treating physician, case manager, vocational specialist), key success factors, and common barriers.

Cornell Notes:

☐ Page 1 — Cue questions: What are the four major functional assessment tools used in case management, and when do you choose each? What is the difference between an ADL and an IADL, and which loss typically drives the need for a higher level of care?

☐ Page 2 — Cue questions: What is maximum medical improvement (MMI), and what changes in the case management role once MMI is reached? What are the four workers' compensation disability categories, and what is the difference between stay-at-work, return-to-work, and transitional duty?

Week 7 — Part VII: Ethical, Legal, and Practice Standards

Difficulty: Moderate–Heavy

What it covers:

• The CCMC Code of Professional Conduct applied to daily practice decisions, including when a situation requires consultation, escalation, or formal ethics review

• The four principles of biomedical ethics — autonomy, beneficence, nonmaleficence, and justice — alongside fidelity and veracity

• Informed consent and shared decision-making — capacity, voluntariness, and understanding

• HIPAA privacy, security, and breach notification standards applied to disclosures, documentation, and team communication

• ADA, FMLA, and related employment laws supporting clients and caregivers facing illness, disability, and workplace impact

• Risk management, liability, and mandatory reporting standards — recognizing and acting on situations requiring formal reporting or escalation

• Advance directives, POLST/MOLST, and end-of-life decisions — legal documents, surrogate hierarchy, and clinical reality

Print: 1 Mind Map, 3 Comparison Charts, 2 Cornell Notes pages

Study Tasks

☐ Read the Study Guide first — complete the High-Yield Objectives, Key Terms and Definitions, and Concept Overview sections before opening the chapter.

☐ Highlight as you read — follow the Made Easy Highlighting System 

☐ The four principles of biomedical ethics — autonomy, beneficence, nonmaleficence, justice — are tested in scenario form, and the test is which principle should guide the response when two conflict. Autonomy: the client's right to make their own healthcare decisions free from coercion, which is the legal foundation of informed consent. Beneficence: the duty to act in the client's best interest. Nonmaleficence: the duty to do no harm. Justice: fair and equitable distribution of benefits and resources. Fidelity and veracity are often added — faithfulness to commitments and truth-telling. Expect a scenario that pits two of these against each other and asks which principle takes precedence in the case manager's response.

☐ Informed consent has four required elements — be able to name all four and identify what invalidates each. Capacity: the client must have the cognitive ability to understand the decision. Disclosure: the provider must share the diagnosis, proposed treatment, alternatives, risks, benefits, and consequences of refusing. Understanding: the client must demonstrate comprehension (often verified with teach-back). Voluntariness: the decision must be free from coercion. Capacity is decision-specific — a client may have capacity for a simple decision but not a complex one, and capacity can fluctuate with cognition, mood, and medications.

☐ HIPAA is tested heavily — know the distinction between the Privacy Rule and the Security Rule. The Privacy Rule governs the use and disclosure of protected health information (PHI) in any form. The Security Rule governs the administrative, physical, and technical safeguards specifically for electronic PHI (ePHI). The Breach Notification Rule requires notification to affected individuals, HHS, and (for breaches over 500 individuals) the media. Minimum necessary is the operating principle — disclose only what is required for the purpose. The case manager's response to a violation is always to report and document, never to cover up.

☐ ADA versus FMLA is a frequent comparison question. ADA (Americans with Disabilities Act) prohibits discrimination based on disability and requires reasonable accommodation in employment — applies to employers with 15+ employees, and is a permanent, ongoing protection. FMLA (Family and Medical Leave Act) provides job-protected unpaid leave of up to 12 weeks for serious health conditions, family caregiving, or new child — applies to employers with 50+ employees and to employees with 12+ months of service and 1,250+ hours worked. ADA accommodates; FMLA protects time off. They often work together but solve different problems.

☐ Advance care planning has a specific document hierarchy. Living will: states the client's wishes about future medical care if they cannot speak for themselves. Healthcare power of attorney (proxy, durable POA for healthcare): names a surrogate decision-maker. POLST/MOLST: actionable medical orders signed by a clinician, portable across settings — a step beyond a living will because it is a medical order, not a wish. Know the surrogate decision-maker hierarchy when no advance directive exists — most state statutes follow spouse → adult child → parent → adult sibling, but specific order varies by state.

☐ Complete the Practice Questions for Part VII in your quiz bank. Review every rationale — correct and incorrect.

How to Use Your Templates

☐ Mind Map: Central node = Ethical, Legal & Practice Standards. Main branches: CCMC Code of Professional Conduct → Four Principles of Biomedical Ethics (autonomy, beneficence, nonmaleficence, justice; fidelity, veracity) → Informed Consent & Shared Decision-Making (capacity, disclosure, understanding, voluntariness) → HIPAA (Privacy Rule, Security Rule, Breach Notification) → Employment Law (ADA, FMLA, EEOC) → Risk Management, Liability & Mandatory Reporting → Advance Directives, POLST/MOLST, End-of-Life Decisions & Surrogate Hierarchy.

Comparison Charts:

☐ Chart 1 — Autonomy vs. Beneficence vs. Nonmaleficence vs. Justice: Definition, example of each principle in action, an example of a scenario where two principles conflict, and which principle typically takes precedence in an informed-consent discussion.

☐ Chart 2 — HIPAA Privacy Rule vs. Security Rule vs. Breach Notification Rule: What each protects, the kinds of information covered, the safeguards required, three common violation examples in a case management setting, and the case manager's reporting obligation.

☐ Chart 3 — ADA vs. FMLA: What each protects (discrimination vs. job-protected leave), employer size threshold, employee eligibility, duration of protection, and a representative case management scenario where each applies.

Cornell Notes:

☐ Page 1 — Cue questions: What are the four principles of biomedical ethics, and how do you decide which principle takes precedence when two conflict in a case management scenario? What are the four required elements of valid informed consent, and what conditions invalidate each?

☐ Page 2 — Cue questions: What is the difference between the HIPAA Privacy Rule, the Security Rule, and the Breach Notification Rule, and what is a case manager's reporting obligation for each type of violation? What is the difference between a living will, a healthcare power of attorney, and a POLST/MOLST, and what is the standard surrogate decision-maker hierarchy when no advance directive exists?

Week 8 — Full Review & Exam Simulation

Your final week is not about learning new material — it is about consolidating everything you have built and proving it under exam conditions.

Review Tasks

☐ Re-draw one Mind Map from memory for each Part you feel least confident about. Check it against your original.

☐ Work through your Cornell Notes cue columns for every Part — cover the right-hand notes and answer from memory.

☐ Re-do any quiz bank questions you got wrong across all Parts. Focus on the rationales.

☐ Review the Common Mistakes, Rapid Review, and Self-Assessment Checklist sections for your two or three weakest Parts.

Exam Simulation

☐ Take the full-length CCM practice exam using the QR code in the back matter of this book. Complete it in one sitting, timed, as close to real exam conditions as possible.

☐ Review your emailed score report. Identify which Parts you missed most and spend your remaining time on those Parts' Rapid Review and clinical scenarios only.