Complex Case Management for National Committee for Quality Assurance Delegation

Activity description

National Committee for Quality Assurance (NCQA) Case Management Accreditation is a comprehensive, evidence-based program dedicated to quality improvement that evaluates the operations of case management programs in provider, payer or community-based organizations. The standards are designed for organizations providing case management services that include patient identification and assessment, care planning, care monitoring and care transitions to meet the needs of patients and their families. This activity will define the role of the NCQA and take a deep dive in the initial assessment of case management, best practices and tools for success.

Provided by
This activity is provided by OptumHealth Education and Optum Care.

Commercial support
No commercial support was received for this activity.

Hardware/Software Requirements
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Target Audience

This activity is designed to meet the educational needs of case managers, nurses and social workers providing case management services.

Learning Objectives

At the end of this educational activity, participants should be able to:

  • Define complex case management (CCM) and the eligibility criteria for participating members.
  • Describe the required criteria for CCM file selection for the NCQA survey.
  • Demonstrate compliance with the NCQA CCM standards.
  • Evaluate delegate CCM files for compliant and non-compliant data elements.
Activity summary
Available credit: 
  • 5.00 ANCC
  • 5.00 Attendance
  • 5.00 CCMC - General
  • 5.00 ASWB
Activity opens: 
09/01/2021
Activity expires: 
09/01/2024

Faculty/Planners
Dawn M. Borgwardt, BSN, RN, CCM
Clinical Quality Consultant
UCS Regulatory Adherence and Accreditation, Medicare & Retirement
UCS Clinical Services

Sarah Chart, RN
Vice President
OptumHealth Education

Rebecca Gleason, RN, CCM
Clinical Planner
OptumHealth Education

Lolly Bilous, MSN, RN, CCM
Associate Director
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance
Optum Care

Maria A. Hancock, BS, RN
Clinical Quality Consultant
UCS Regulatory Adherence and Accreditation, Medicare & Retirement
UCS Clinical Services

Amy Holdren, BSN, RN, CCM
Senior Clinical Program Consultant
DSNP Medical Management Implementation Team
Clinical Consistency and Safety
Clinical Performance
Optum Care

Lilly L. Lerma, RN, BSN
Clinical Consultant
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance
Optum Care

Claudia B. Martinez, MSN, ANP-BC
Clinical Quality Consultant
UCS Regulatory Adherence and Accreditation, Medicare & Retirement
UCS Clinical Services

Valerie Ventura, MSN, RN
Vice President
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance 
Optum Care

Tiffany Younts, MSN, RNC-OB, CCM
Training Consultant 
Clinical Adherence and Remediation
Clinical Consistency and Safety
Clinical Performance
Optum Care

Disclosures of relevant financial relationships
In accordance with the Accreditation Council for Continuing Medical Education's (ACCME) Standards for Integrity and Independence in Accredited Continuing Education, OptumHealth Education (OHE) requires all those in control of educational content to disclose their financial relationships with ineligible companies within the prior 24 months. Ineligible companies are defined by the ACCME as companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients. Individuals must disclose all financial relationships, regardless of the amount, with ineligible companies and regardless of their view of the relevance of the relationship to the education. OHE ensures that the content is independent of commercial bias.

The activity faculty or planners have no financial relationships to disclose.

Method for calculating CE credit
CE credit was calculated by the complexity of content.

Accreditation Statement
Joint LogoIn support of improving patient care, this activity has been planned and implemented by OptumHealth Education and Optum Care. OptumHealth Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE) and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Credit Designation Statements

Nurses
The participant will be awarded up to 5.00 contact hours of credit for attendance and completion of supplemental materials.

Nurse practitioners
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.

Social workers
ACE LogoAs a Jointly Accredited Organization, OptumHealth Education is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. OptumHealth Education maintains responsibility for this course. Social workers completing this course receive 5.00 enduring continuing education credits.

Case managers
The Commission for Case Manager Certification has approved this program for a maximum of 5.00 clock hours for Certified Case Managers (CCM).

Attendance
A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been pre-approved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization with which they wish to obtain credit.

Available Credit

  • 5.00 ANCC
  • 5.00 Attendance
  • 5.00 CCMC - General
  • 5.00 ASWB
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