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CASE MANAGEMENT URAC GAME Flashcards | StudBud
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CASE MANAGEMENT URAC GAME
CASE MANAGEMENT URAC GAME
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41 cards
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Questions
41
Answers
1
What is the first step to take if you experience access issues?
Continue working on affected tasks until it’s resolved
Wait until the access issue resolves itself
Implement the Business Continuity Plan and contact your supervisor
Contact IT support immediately
2
Is the case management process standardized?
The case management process is based on personal preference
No, the process varies depending on the case
Only the steps involving coordination of care are standardized
Yes, it follows professional standards, licensure & certification scope
3
How can you access the company's Code of Conduct?
By requesting a copy from a coworker
By contacting the Compliance Director
Through the Employee Hub or by contacting HR
It’s only available in paper form
4
Quality management program includes projects as measuring timeliness, conducting member surveys, & reviewing complaints.
False
True
5
Who does a Case Manager collaborate with to provide comprehensive care❓ select all that apply
No one; a Case Manager works alone
Only with the treating provider & member
The member, caregivers/family, treating providers & facilities
The interdepartmental disciplines (DM, triage, UM)
6
How do you decide on interventions for a member❓
By using past intervention outcomes
Based on the member's assessment, clinical reviews pharmacy reports and APS
Based on the member’s preferences only
By consulting external specialists for advice
7
When is training on the Code of Conduct provided?
Only once a year
Only when a violation occurs
Only once when hired
Upon hire and as needed for ongoing compliance
8
If you observe legal or regulatory breaches, how should you report it?
Ignore it unless it's a serious violation
Report it to the Compliance Director or HR
Report it to your direct supervisor
Report it to a coworker
9
Promoting medication independence involves only reviewing prescription reports for necessary interventions.
True
False
10
What does the organization do in response to an immediate threat to the health and safety of the member?
Wait until the threat resolves itself
Refer the member to a specialist
Follow the protocol outlined in Core 23
Contact the police immediately
11
Case Managers only collaborate with the member and caregivers to provide care.
False
True
12
(If you get a new computer): The old computer is kept for backup purposes, even if sensitive information is not wiped.
False
True
13
All case management work is delegated to other departments.
True
False
14
Where can you find the P&P documents?
In Teams' Care360 All Channel or on SharePoint
Only in the employee handbook
On a shared drive accessible only by supervisors
Only on paper in the office
15
The company's Code of Conduct can be accessed through the Employee Hub or by contacting HR.
False
True
16
If you observe a legal or regulatory violation, you should report it to your coworkers first.
False
True
17
Case management services are delivered on time by following P&P and responding within 24 hours
False
True
18
The Code of Conduct covers topics such as fraud, abuse, and conflict of interest.
True
False
19
Care plans are created using only the personal preferences of the member.
True
False
20
What type of information is used to create care plans?
Only the treating provider's notes
Only the caregiver’s feedback
Member information and evidence-based guidelines
General health information without any specific guidelines
21
What tools do you use to complete a member assessment?
Assessments based on MCG, clinical reports, claims data and medical history
Just the member's medical history
Only pharmacy reports
Only clinical reports
22
If PHI is lost, notify your supervisor and collaborate with Compliance and Security Officers
False
True
23
Members have access to their Rights & Responsibilities.
False
True
24
What is a Case Manager's primary responsibility?
To provide medical treatment to the member
To create care plans, coordinate care, and collaborate with the team.
To only schedule appointments for the member
To manage the insurance claims for the member
25
A financial incentive is offered that could influence medical decision-making based on consumer utilization of services.
True
False
26
Which of the following is
NOT
a method used to prevent the loss of Personal Health Information (PHI)?
Using unique passwords
Ensuring a locked workspace
Maintaining a paperless environment with dual monitors
Using shared accounts for easier access
27
How do you promote health literacy for the member❓
By using plain language, "read-back" technique, and open-ended questions
By asking the member to research their care plan
By using medical jargon to explain their care plan
By offering written instructions only
28
The primary tool used to perform your job is the organization’s Policies & Procedures (P&P).
False
True
29
How can a member access their Rights & Responsibilities for the Care Management Program? Select ALL
By receiving it with their insurance card
By requesting it or accessing it on the Imagine360 website.
By calling their healthcare provider directly
Go to Imagine360.com➡click about scroll to bottom of page
30
If a member does not meet criteria for case management, you should proceed without any further review.
False
True
31
The case management process follows standardized practices to ensure patient-centered care.
False
True
32
Training on the Code of Conduct is only provided during the hiring process
False
True
33
How are you involved with the quality management program?
By only completing documentation
By handling customer complaints
By observing quality projects without participating
By participating in training, audits, and reviewing reports.
34
What is your role in the consumer complaint process❓
Ignore the complaint unless it is escalated
Resolve the issue, de-escalate, and transfer to a supervisor if needed.
Only document the complaint for follow-up
Transfer the complaint to HR without addressing it
35
Who is involved with the quality management program❓
Only Supervisors
Only frontline staff
Diretor, Supervisors, Managers, and the Medical Director
Only the Medical Director
36
The primary role of a Case Manager is to coordinate care and assist with care transitions.
False
True
37
How are changes to the P&P communicated?
Through annual training, team meetings, or email as needed
Through personal messages from management
Only through email
Changes are not communicated
38
A member is considered appropriate for case management based on the criteria outlined in the P&P.
False
True
39
Which of the following is
NOT
a topic covered in the Code of Conduct?
Ethical business practices
Conflict of interest
Personal financial planning
Fraud & abuse
40
Case Managers communicate collaboration details with the member or caregiver only through written communication.
False
True
41
What is one method a Case Manager can use to communicate the details of collaboration with a member or caregiver❓
Only through written documents
Sending an email only
Posting an update on social media
Verbally, through an introductory letter, an APS, or a call to the provider
