Nursing Theorists
Who is known as the founder of modern nursing and introduced hygiene practices in healthcare?
Who is Florence Nightingale
What process involves identifying potential risks to patient health and safety to prevent complications?
What is Risk Assessment
This is the initial step in the case management process
What is an assessment?
The Assessing phase involves the collection of information about a client's situation similar to those during Screening, however to greater depth. Give me 3 things that are looked at
What are
Based on our team process, when should you initiate a precall
What is ASAP to help facilitate 2nd opinion if applicable
Which theorist developed the Theory of Human Caring focused on the deep connections between nurses and patients
Who is Jean Watson
What is Patient Advocacy
What is the practice that involves nurses supporting and promoting patients' interests and ensuring their rights
What is service coordination or implementation
During this phase, you the case manager generate outcomes reports such as case summary, quality, cost/billing, satisfaction, outcomes, cost-benefit analysis, and return on investment. You also communicate the findings or disseminate the reports to key stakeholders
What is the evaluation phase of case management
Based on our HCC process what is the dollar amount to imitate a provider collaboration
What is 200K and 150K for Netflix members
What theory is Madeleine Leininger famous for
What is is the theorist that introduced the concept of transcultural nursing?
What process involves preparing a patient for leaving the hospital with the necessary instructions and follow-up care
What is Discharge Planning
What approach involves integrating clinical expertise with the best available research and patient values
What is Evidence-Based Practice
Name two clients that have the Specialty Rx Savings Navigator
Who are GCIC, New Haven
What are three types of denials you will expect to see for an outcome notification
What are Admin or contractual denial, LOI and medical necessity denials
Which theorist is known for the Goal Attainment Theory in nursing care?
Who is Imogene King
Describe Continuity of Care
What is the consistent and seamless provision of care across different healthcare settings
What happens during the Monitoring and Evaluation stage of the CM process
What is the ongoing process in case management which involves tracking the client's progress and adjusting the care plan as needed.
Knowing the stages of change is an important component for MI, what are the stages of change
What are pre-contemplation, contemplation, preparation, action, maintenance and relapse
What process refers to the legal right of a health plan, or a federal or state governmental program paying for health care, to recover sums paid for a member’s health care from a legally liable third party, the third party’s insurer, or a workers’ compensation insurer or program.
What is subrogation
Which theorist is renowned for the nursing process theory, emphasizing immediate patient needs and responses
Who is Ida Jean Orlando
What practice ensures that a patient’s health services are well-organized and seamless across various healthcare settings
What is Care Coordination
What approach in nursing focuses on caring for the whole person, including their physical, mental, emotional, and spiritual needs
What is Holistic Care
What is the minimum daily engagement goal we recommend for optimal success
What is a minimum 2 engagements/texts per day
Name 5 types of cases you will see on your assignment sheets
What are
TI/PR
HCC
AIM
ERR
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