Care Excellence for Health Plans   

Learn the principles of advance care planning, how to communicate the critical reasons for ACP and have productive ACP conversations, how to engage clients with selecting a power of attorney as well as understanding the documents involved with advance care planning, including advance directives and medical/physicians orders for life-sustaining treatment.

Learners will begin by gaining general definitions of dementia and Alzheimer’s disease, and will progress through a comprehensive review of causes, stages and risk factors. Care planning for persons with ADRD, barriers to care and key issues in care planning starting with detection and diagnosis, moving through symptom management, environmental and behavioral modifications to support quality of life and caregivers, along with care settings, resources and advocacy, will be covered

Care Managers have the responsibility to determine a client’s ability to consent to services. It is not always easy to determine if a person has issues with capacity or literacy. This module will prepare care managers for understanding the differences between capacity and literacy, determining when a client has capacity concerns versus literacy issue, and how to address the situation once a determination has been reached.

A thorough understanding of the core elements of case management enables new care managers to become grounded in the true purpose and goals of this important work. Care managers will learn the ins and outs of the assessment, micro and macro elements of care coordination, how to make a successful referral, and how to monitor ongoing progress of clients. The fundamental aspects of crisis management, including prevention of crises, are also covered.

Effective case management relies upon multiple professionals working together to solve the myriad of medical, functional, social, and environmental issues that contribute to a person’s ability to achieve care goals. This module details ways that care management teams improve safety and quality of care through collaboration with members of an interdisciplinary care team as well as ancillary service providers and organizational partners.

Proficient care planning is a skill that should not be underestimated, especially in the current environment of complex health care needs. In this module, care managers learn the core elements of care planning, which will enable care managers to become grounded in the true purpose and goals of this important work. This module also provides care managers with tools, techniques, and strategies for developing purposeful and robust person-centered care plans that address the multitude of complex issues within the client’s environment

This course provides a comprehensive picture of what case management is, where it fits within the broader healthcare system, and the vital role care managers play in improving health and well being for large populations of people.

Research has demonstrated that achieving health and wellness goals depends upon a strong community network of partners working together to address the social determinants of health. For example, individuals who lack access to reliable or safe transportation are less likely to make follow-up appointments with care providers. This module explores strategies for identifying community partners – both public and private sector organizations – in order to meet the needs of clients. Opportunities for developing and achieving mutually beneficial partnership goals will be described, including examples of successful partnerships. It concludes with a discussion regarding the use of joint taskforces to develop resources that benefit clients.

Care management is most effective when a client is evaluated in his/her own setting; therefore, in complex situations, care managers are required to complete home visits. This module details how to skillfully complete a home visit including: how to safely and positively interact with the client at home, how to comprehensively evaluate the living space of the client, how to interact with and engage the support system in care planning, and how to evaluate the community and environmental factors present in the space where the client resides

The modules in this course focus on the case manager’s role as a care coordinator among multiple agencies and as an educator to the member. Gain insights on improving care for high-risk patient populations, recognizing urgency, gaps in care, and opportunities to improve care and outcomes. Includes a review of critical thinking skills focused on problem solving best practices.

The modules in this course focus on the case manager’s role as a care coordinator among multiple agencies and as an educator to the member. Gain insights on improving care for high-risk patient populations, recognizing urgency, gaps in care, and opportunities to improve care and outcomes. Includes a review of critical thinking skills focused on problem-solving best practices.

Clients in care management often have complex medication regimens as a result of chronic medical conditions. A challenge for care managers is confirming and reconciling medications. In this module, care managers learn how to confirm and reconcile medications effectively, what to assess for relative to client medication regimen needs, tools for improving medication adherence, and strategies for working with multiple prescribing providers.

An ongoing challenge care managers face is working with clients who experience both medical and behavioral difficulties in care. In this module, care managers learn the ins and outs of working with complex medical and behavioral clients including tools for soliciting information, techniques for effectively building rapport, and strategies for care planning. Additionally, this module teaches care managers skills for client advocacy and improved working relationship with health care providers, community resources, and support systems for clients faced with medical and behavioral challenges.

Care managers provide services within an intricate system of Medicare and Medicaid based programs. One of these programs is Long Term Care Services. In this module, care manages learn how to navigate the intricacies and nuances of the various programs and settings within Long Term Care Services and Support. This module provides an understanding about the different programs and qualifying factors, information on accessing specific benefits authorized in the Social Security Act, and methods for identifying and referring clients to Long Term Services and Support programs.

This first motivational interviewing online module focuses on defining motivation in relation to your work with clients, understanding the evidence base behind it, including limitations and situations when it isn’t effective, and defining the impact of culture on motivation. Care managers will learn how to embrace the spirit of motivational interviewing in order to encourage people to establish person-centered goals and plans. In addition, care managers will identify dynamics that can jeopardize their ability to provide effective client support

Critical thinking skills allow care managers to identify the underlying issues that impact a clients’ ability to achieve their goals. This module provides an in depth look at the practice of self-disciplined reasoning including emotional reasoning, pragmatic reasoning and epistemic reasoning. Care managers will learn strategies to improve critical thinking skills and apply the concepts of critical thinking, reasoning, and reflective thought through demonstrated case scenarios

Managing high risk clients requires the continual application of critical thinking skills in the moment and the ability to look ahead to identify and mitigate risks. This module provides advanced tools for enhancing critical thinking and risk management that are critical to every care manager working with complex cases.

In this module, participants will explore the common chronic diseases that cause the major morbidity and mortality to the US population. While some modules are broken down by disease process, such as Cancer and Diabetes, or symptoms such as Chronic Pain, others explore organ systems and the diseases that afflict those systems; ex. Pulmonary Diseases and Heart Disease. All of the modules discuss the pathophysiology of the disease processes, how these diseases cause damage to the body. They then discuss the diagnosis and treatment modalities. Finally, they explore the ways that providers can educate patients and caregivers in those management strategies in order to promote improved quality of life.

Learners will gain an understanding of the dynamics of domestic violence, and be able to recognize and describe different types of domestic violence, the characteristics of an abuser and victim of abuse, analyze and assess why victims remain in relationships, and the risks associated with ending a violent relationship. Information about the impacts of domestic violence on children, friends and families will be included, as well as resources available to support victims of domestic violence

Care management is not a life-long program, but rather a program designed to provide support to clients during complex and challenging periods. This module teaches care managers about the importance of establishing goal and discharge criteria in care plans. It also provides care managers with skills for identifying client milestone achievement, tools for helping clients recognize and accept self-readiness, and supportive methods for graduating clients out of care management into self-advocacy and self-direction of care.

Care Managers are obligated reporters; however, it is not always clear when reporting is required. In this module, care managers will learn how to effectively evaluate situations based on mandatory reporting protocols to protect clients, while simultaneously preserving professional integrity. This module also details who or what populations should be covered under mandatory reporting; and when reporting is not mandatory due to privileged information versus when reporting is mandatory based on professional responsibility.

Communication and documentation are critical for effective care management; however, meaning can sometimes be elusive, misunderstood or not interpreted clearly. Care managers will learn how to effectively understand and interpret communication in written, verbal, and non-verbal form. Additionally, care managers will learn skills for enhancing meaningful communication in all settings with clients and other professionals to improve every day interactions, creating healthy forums for problem solving, and engaging in robust collaboration.

Care managers can serve a variety of roles as educators, coordinators, clinicians, quality managers, negotiator,s and advocates. Depending on the work environment care managers may be called upon to serve clients telephonically or face to face. This module explores the benefits and barriers involved in both types of service delivery as well as the technology that facilitates case management in all settings.

Care plans must be person-centered and meet the needs of the individual client; however, they can only be person-centered if the client is activated and engaged in the process. In this module, care managers gain a comprehensive understanding of the benefits of activation and engagement and the barriers of activation and engagement. More importantly, this module provides care managers with tools and strategies for facilitating activation and engagement.

The fourth course in the Foundational curriculum provides care managers with skills for obtaining more comprehensive and clear information about the clients they work with on a daily basis. In order to “Get the Whole Picture” care managers must have enhanced skills at dissecting information, probing for more detail, and evaluating external factors

Care managers work within an evolving healthcare management and delivery system. Effective care managers understand the structures within which their services are provided. Care managers will learn about different types of health plans, new models for healthcare delivery including ACOs, and case management practice settings

Care Managers will learn the definition of homelessness per the current definition of the US Department of Housing and Urban Development, and will gain an understanding of homelessness in America and common elements of the experience of people experiencing homelessness. Topics including risk factors for homelessness, how public policy impacts homelessness, needs for care and barriers to care experienced by the homeless, and best practices for interventions and programs for the homeless will be explored as well.

The learner will begin the module exploring the history & philosophy of hospice, progressing into current models, services provided in various settings, and payment structures. Professionals typically within hospice teams, their roles and contributions are covered; with continued progression into symptom management, family dynamics, meaning-making, spirituality, and advance care planning as part of hospice are covered. Dying and what to expect, and grief and bereavement conclude the module.

A Care Manager’s role is to facilitate access to health care to plan members regardless of their immigration status. Information on the challenges and barriers immigrants face when seeking health care, on resources, on listening to fears and concerns, and how to assist with program enrollment is covered in this module.

This module will introduce the collaborative professional role Case Managers perform and the necessary case management strategies to improve transitional care for high-risk patient populations. Focus is on needs assessments, brokerage and monitoring of health care services and resources, comprehensive assessments, care coordination practices, proactive discharge planning, patient/family advocacy, and the provision of appropriate transitional care interventions. These interventions include culturally and linguistically appropriate education, supportive, and counseling strategies to enhance self-care management and empower patient/care-giver to manage their chronic illness and symptoms management

Care Managers will learn definitions of intellectual and developmental disabilities and review of federal and state regulations protecting this population. Nuances of individuals with IDD, such as environmental impact on behavior and engagement with patient/client, triggers, techniques, along with patient/client, family and caregiver engagement and best practices and resources will be covered as well.

With complex patients, the challenges of care coordination increase as the number of programs and agencies involved increase. Learn strategies for dealing effectively in a complex multi-faceted environment while ensuring optimal care coordination for clients. Take the sophistication of your coordination skills to a new level.

Explore interdisciplinary collaboration techniques to develop and support client care plans. Gain skills in identifying key team members, approaches for collaboration, communication,and leading team meetings.

This course provides an understanding of incarceration’s effect on the individual, prevalent health needs of incarcerated individuals, and social challenges of justice. An overview of reentry, with necessities for individual reentry transitions is also covered.

This module will inform and provide Care Managers an overview about LGBTQ+ health care incongruities, as well as an LGBTQ+ Affirmative approach for working with patients in order to develop self- esteem, nurture empowerment, establish self- efficacy, and social consciousness while combating the effects of homophobia, transphobia, heterosexism, cissexism and toxic shame. LGBQ+ and Transgender terminology, definitions, and concepts will be defined, and information to increase sensitivity and competency through knowledge of the population’s needs, such as identification as an Ally, and do’s and don’ts will be shared. Barriers to care, ways to overcome them, assisting to empower through learning history, myths, resources and knowledge conclude the module.

The goal of managed care is to increase member satisfaction and health, while reducing hospitalizations and costs. This module details the important concepts of utilization management, resource management, adherence, and quality are covered in this module. Care managers will also learn how data is used to implement strategies across client populations

Clients in care management often have complex and multiple chronic conditions. In this module care managers will learn about multiple chronic conditions, how to assess clients successfully when multiple chronic conditions are presented, how to evaluate functional status and performance in a multiple chronic condition setting, and how to manage and coordinate care for these individuals. This module also details how care managers can effectively manage multiple care providers within a multiple chronic condition care dynamic.

Effective care managers are able to foster strong relationships with clients, built upon a foundation of respect and trust. This module teaches care managers ways to leverage their own self-awareness and utilize interprofessional skills to build trust and engage clients in the care planning process. Care managers will learn active listening, proactive communication, and how to effectively acknowledge client emotional responses. It concludes by providing a process to help clients identify problems and set goals.

Learners will gain definitions of members of this population, and will explore myths and misconceptions. Needs of this population including treatment, therapy, education and accommodation, employment and social support will be explored. People with mental illness have barriers to care in the healthcare system, and their significance and prevalence within healthcare system is covered, along with nuances of the population (do’s and don’ts) and best practices, family and caregiver engagement and support and navigating the system for special/unique resources and programs available to address their unique needs.

Uncovering a person’s underlying motivations allows care managers to work with them to establish desirable and achievable care plan goals to improve their health. Motivational interviewing can improve client engagement, help to resolve client ambivalence, and promote client activation in activities that lead to better health outcomes. This in-depth course teaches strategies to assess and strengthen an individual’s motivation to take action.

Uncovering a person’s underlying motivations allows care managers to work with them to establish desirable and achievable care plan goals to improve their health. Motivational interviewing can improve client engagement, help to resolve client ambivalence, and promote client activation in activities that lead to better health outcomes. This in-depth course teaches strategies to assess and strengthen an individual’s motivation to take action.

With the rise of opioid use and overdose related deaths, research for alternative treatment approaches to pain management is expanding. Understanding how pain affects the “whole” person’s (physical, emotional, social, environmental) functioning provides the foundation for developing a comprehensive pain relief treatment program. Through exploring the history of pain management, types of pain, and how pain affects a person’s functioning, health care professionals completing this course will be better prepared to complete thorough assessments and provide safe and effective pain management treatment interventions.

Care managers will gain tools to assist in educating patients, families and colleagues about what Palliative Care is and how it can be helpful. The module emphasizes concepts of beneficence and autonomy for patients with serious or life-limiting illness, and gives tools to support communication with patients and families regarding therapy and other choices. Assessment strategies for bio-psycho-spiritual symptoms and for palliative care referrals is also included

Research demonstrates that when patients are activated – that is fully engaged in managing their own health care – they are more likely to achieve their care goals. Activated patients have the knowledge, skills, and willingness to become full participants in their care plan development and implementation. This essential module explores patient activations, focusing on client roles in the process, opportunities to improve client knowledge, skills, and confidence, cultivating client self-advocacy, and promoting long-term empowerment and resilience.

This comprehensive module covers CDC statistics on morbidity and mortality in age ranges from newborn to young adult, wellness checkpoints and immunizations for all age groups, and barriers to healthcare access for children. The module includes exploration of special populations in pediatrics: immigrant, migrant, homeless, foster children, and children with life-limiting illness. It takes the perspective of pediatrics as addressed by medical specialties and subspecialties, from the view of the case manager, then illuminates the primary functions of the case manager in pediatrics in service and resource provision for patient and family, symptom management and resources over time in a child’s course at the end of life, and concludes with self-care for the case manager.

This comprehensive module covers CDC statistics on morbidity and mortality in age ranges from newborn to young adult, wellness checkpoints and immunizations for all age groups, and barriers to healthcare access for children. The module includes exploration of special populations in pediatrics: immigrant, migrant, homeless, foster children, and children with life-limiting illness. It takes the perspective of pediatrics as addressed by medical specialties and subspecialties, from the view of the case manager, then illuminates the primary functions of the case manager in pediatrics in service and resource provision for patient and family, symptom management and resources over time in a child’s course at the end of life, and concludes with self-care for the case manager.

Peer support and mutual professional development creates opportunities for learning from others’ experiences, knowledge, and wisdom. This module explores the benefits of peer support groups, details the indicators of burnout, and identifies ways to prevent and recover from burnout. Care managers also learn the risk factors for potential violence when working with clients and tools for diffusing volatile situations.

In this module, the student will explore the various types, causes and characteristics of physical disabilities and needs disabled people have, including health care, safety, living and technology. Disparities that exist due to physical disabilities, health promotion and disease prevention opportunities, disability etiquette, family and caregiver support will also be explored, along with payment systems, community support systems and best practices.

This course will examine what the general standards are for prenatal care in the “normal” population and how care managers can directly affect outcomes in this population, as part of the health care team. Because in the last 5 years many of the previously routine evaluations and exam components have been challenged, and standards have experienced increased scrutiny, modifications in standards based on current evidence have transpired. This course will provide that new information, as well as care management challenges dependent on an insurance company’s standards, variations among practitioners, and more

Care managers have an ethical duty to maintain healthy relationships with clients, based upon an understanding of transference, value conflicts and confidentiality. These and other key principles, including informed consent and client rights, are detailed in this module. The care manager’s role in relation to protected and vulnerable populations is also explored, with an emphasis on working with seniors and persons with disabilities and dually eligible Medicaid and Medicare populations. Care managers are taught and given the opportunity to apply best practice interventions that positively modify client behaviors.

Clients in care management have distinctive needs that require specific community and advocacy resources in order to reach goals. In this module, care managers learn about the importance of resource identification and development from an individual perspective, a community perspective, and an industry perspective. The module also teaches care managers how to effectively evaluate community and advocacy support systems, how to work with existing programs to meet the specific needs of individual clients, and how to advocate for development of additional programs within communities.

Successful care management requires that care managers understand clients holistically. This means care managers should have a clear understanding of the psychosocial aspects that impact the client’s life. Care managers will learn how to effectively evaluate the environmental factors that impact clients, how to work collaboratively with support systems, and how to assess risk factors and implement interventions for minimizing impact

Learn ways to work with clients to understand their perception of quality of life and to look at the management of their health from a whole-person perspective.

Each of the special populations modules is designed to provide focused content on conditions that may affect members. Each defines the condition, explores myths, misconceptions, statistical data, causes, risk factors, detection and diagnosis, and needs of populations, including treatments, symptom management, and accommodation considerations, employment, social support available, barriers to care in the healthcare system, best practices, special/unique resources and programs available to address the member’s unique needs, and more

A continued exploration of special populations’ conditions, exploring myths, misconceptions, statistical data, causes, risk factors, detection and diagnosis, needs of populations including treatments, symptom management, therapies and more.

Clients in care management have unique and individualistic needs, and sometimes these special need are related to how a client lives, where a client lives, age, accidents, illness, genetics, or other distinctive factors. In this module, care managers will receive an overview of special populations to enhance their understanding of clients’ distinct needs. The populations reviewed will include: People with Mental Illness, Homelessness and Poverty, Substance Use, Pain Management & Chronic Opioid Use, Domestic Violence, Jail and Forensic Health, People with Physical Disabilities, People with Intellectual and Developmental Disabilities, People from the LGBTQ community, Alzheimer’s/Dementia, Traumatic Brain Injury (TBI), Transplant, Pregnancy, and Pediatrics.

Building upon the concepts taught in the Core Principles module, this module details 14 specific motivational interviewing techniques that care managers can immediately integrate into their practice including OARS, affirmations, reflections, rolling with resistance, decisional balance, and numerous others. At the conclusion of this module care managers apply and validate their new knowledge using a video vignette case study.

Gain a thorough introduction to Substance Use Disorder (SUD), and further your understanding of addiction. Learners will also obtain tools for maximizing communication and engagement, as well as treatment options. Learn to address barriers to treatment and to offer support options that can assist in recovery.

Care managers will delve into the nuances of transplant donors and recipients, starting with the Transplant Team’s process of selecting patients for listing on an organ transplant waiting list; the roles of the interdisciplinary transplant team as pertains to selection and listing; will learn the methods applied to wait times for deceased donor organs and the accompanying psychosocial factors that are considered for patient listing. Coping problems that act as barriers to transplant and recovery, identification of populations that have a difficulty meeting psychosocial criteria for listing, and resources applicable in assisting these vulnerable populations are included as well.

Trauma Informed Care is a treatment framework for working with individuals, who have experienced events, or periods of events, of physically or emotional trauma, which impact physical, emotional, mental, and spiritual well-being. Care Managers will learn how to become trauma-informed in their practice by learning how to recognize the effects and complex issues of trauma, how to look for patterns of utilization related to trauma responses, and how trauma impacts health problems, influences social outcomes, and increased cost to social services. Most importantly, care managers will learn how to build a trauma-aware workforce focused on supporting and understanding people who have been traumatized while avoiding unintentional re-traumatization to the individuals they serve

In this course, learners will gain an understanding of types of brain injuries and of their symptoms and side effects. Special and complex needs of individuals coping with brain injuries will be explored, to allow for a thorough understanding of the unique skills for supporting those in the brain injury population. Community and online resources specific to TBI/ABI for continued learning will be provided.

Case management is a specialty area that receives complex care and at-risk patient populations that are referred through different venues that include case-finding, predictive modeling, health risk assessment score, and direct referrals from providers or by patient and patient’s advocate. With an influx of cases that would benefit from case management services, good triage practices are critical to assess urgency, risk level, needs, and gaps in care that would benefit from timely case management interventions. This module covers interventions including culturally and linguistically appropriate education, supportive, and counseling strategies to enhance self-care management and empower patient/care-giver to manage their chronic illness and symptoms management.

A Care Manager’s role is to facilitate access to health care to plan members regardless of their immigration status. Information on the challenges and barriers immigrants face when seeking health care, on resources, on listening to fears and concerns, and how to assist with program enrollment is covered in this module.

Each client is a product of his/her culture as well as being a culture of one. Learn fundamental guideposts in understanding different cultures and the impact of culture on attitudes towards health, communication, decision-making, care planning and adherence.

This course focuses on the role of the case manager in addressing the needs of the whole person, keeping in view the environment in which they live, and other health determinants, to ensuring the client’s perception of the value of both the case manager and the care plan

This comprehensive module covers CDC statistics on morbidity and mortality in age ranges from newborn to young adult, wellness checkpoints and immunizations for all age groups, and barriers to healthcare access for children. The module includes exploration of special populations in pediatrics: immigrant, migrant, homeless, foster children, and children with life-limiting illness. It takes the perspective of pediatrics as addressed by medical specialties and subspecialties, from the view of the case manager, then illuminates the primary functions of the case manager in pediatrics in service and resource provision for patient and family, symptom management and resources over time in a child’s course at the end of life, and concludes with self-care for the case manager.

Factors like socioeconomic status, education, the physical environment, employment, and social support networks all exert significant influence on an individual’s health. Learn about how to work with clients to mitigate the negative impact and enhance the positive influence of non-health issues on health