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Latest 2025 Updated ANCC Nursing Case Management Certification Questions and Answers

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CMGT-BC Exam Format | CMGT-BC Course Contents | CMGT-BC Course Outline | CMGT-BC Exam Syllabus | CMGT-BC Exam Objectives

Certification Name: Nursing Case Management Certification (CMGT-BC)

Credential Awarded: CMGT-BC (Case Management-Board Certified)

Administered By: American Nurses Credentialing Center (ANCC)

Eligibility: Open to registered nurses (RNs) who meet specific practice and education requirements.

Exam Format: Computer-based test (CBT)

Exam Length: 3.5 hours (including 15 minutes for a tutorial and 15 minutes for a post-exam survey)

Number of Questions: 175 questions (150 scored, 25 unscored pretest questions)

Question Types: Multiple-choice questions (MCQs)

Passing Score: Scaled score system (details on passing criteria are not publicly disclosed by ANCC)



- Foundations of Case Management

- Definition and Scope of Case Management:

- Understanding the role

- responsibilities

- goals of a case manager

- Case Management Models:

- Familiarity with various models such as the Collaborative Model

- Brokerage Model, and Clinical Case Management Model

- Standards of Practice:

- Knowledge of the Case Management Society of America (CMSA) Standards of Practice and the American Nurses Association (ANA) standards.

- Ethical and Legal Considerations:

- Understanding ethical principles

- confidentiality

- informed consent

- legal issues in case management

- Regulatory and Accreditation Requirements:

- Familiarity with regulations such as HIPAA

- Medicare/Medicaid guidelines

- accreditation standards (e.g., Joint Commission)



- Care Coordination and Transitions of Care

- Care Coordination Principles:

- Strategies for coordinating care across multiple providers and settings.

- Transition Planning:

- Ensuring smooth transitions between healthcare settings

- hospital to home

- acute care to long-term care

- Discharge Planning:

- Developing and implementing effective discharge plans to prevent readmissions.

- Interdisciplinary Collaboration:

- Working with healthcare teams

- including physicians

- social workers

- therapists

- optimize patient outcomes



- Patient-Centered Care

- Patient Advocacy:

- Ensuring the patients voice is heard and their preferences are respected.

- Cultural Competence:

- Providing care that is sensitive to the patients cultural

- religious

- social background

- Health Literacy:

- Assessing and addressing the patients ability to understand and act on health information.

- Patient Education:

- Educating patients and families about their conditions

- treatment options

- self-care strategies



- Utilization Management

- Resource Management:

- Efficient use of healthcare resources to achieve optimal patient outcomes.

- Cost-Effective Care:

- Balancing quality care with cost containment.

- Prior Authorization and Denial Management:

- Understanding insurance requirements and managing denials or appeals.

- Evidence-Based Practice:

Using research and clinical evidence to guide decision-making.



- Quality and Outcomes Management

- Quality Improvement:

- Implementing strategies to improve healthcare quality and patient safety.

- Performance Metrics:

- Understanding key performance indicators (KPIs) such as readmission rates

- patient satisfaction scores

- length of stay.

- Outcome Measurement:

- Evaluating the effectiveness of case management interventions.

- Risk Management:

- Identifying and mitigating risks to patient safety and organizational liability.



- Healthcare Reimbursement and Financing

- Payment Models:

- Understanding fee-for-service

- value-based care

- bundled payments.

- Reimbursement Systems:

- Familiarity with Medicare

- Medicaid

- private insurance reimbursement processes.

- Cost-Benefit Analysis:

- Evaluating the financial impact of case management interventions.

- Budgeting and Financial Planning:

- Managing budgets and resources within a case management program.



- Population Health Management

- Health Promotion and Disease Prevention:

- Strategies for improving population health outcomes.

- Chronic Disease Management:

- Managing conditions such as diabetes

- heart disease

- COPD.

- Social Determinants of Health:

- Addressing factors such as housing

- education

- socioeconomic status that impact health outcomes.

- Community Resources:

- Connecting patients with community-based services and support.



- Technology in Case Management

- Health Information Systems:

- Using electronic health records (EHRs) and case management software.

- Telehealth:

- Leveraging telehealth for remote patient monitoring and consultations.

- Data Analytics:

- Using data to identify trends

- measure outcomes

- improve care delivery.

- Privacy and Security:

- Ensuring the confidentiality and security of patient information.



- Professional Practice

- Leadership and Advocacy:

- Leading case management teams and advocating for policy changes.

- Professional Development:

- Engaging in continuing education and staying current with best practices.

- Certification and Licensure:

- Understanding the requirements for maintaining CMGT-BC certification and state licensure.

- Interprofessional Collaboration:

- Building effective relationships with other healthcare professionals.

- Case Management Process:

- Assessment

- planning

- implementation

- coordination

- monitoring

- evaluation.

- Care Plan:

- A documented plan outlining the patients goals and interventions.

- Continuity of Care:

- Ensuring seamless care across different providers and settings.



- Determinants of Health:

- Factors that influence health outcomes

- genetics

- behavior

- environment.

- Health Equity:

- Ensuring fair and equal access to healthcare resources.

- Patient-Centered Medical Home (PCMH):

- A care delivery model focused on comprehensive

- patient-centered care.

- Value-Based Care:

- A healthcare delivery model that rewards quality and outcomes rather than volume of services.



- ANA Code of Ethics for Nurses with Interpretive Statements

- CMSA Standards of Practice for Case Management (eg, patient advocacy)

- Concepts of nursing case management

- Nursing scope and standards of practice

- Utilization management (eg, authorizations, denials and appeals)



- Benefit management (eg, payor reimbursement, cost sharing, coordination of benefits)

- Resource coordination (eg, providers, community)

- Transition of care management (eg, planning, facilitation, evaluation)

- Data management (eg, collection, analysis, benchmarking)

- Performance improvement (eg, outcome measurement and evaluation)



- Patient education (eg, readiness for change, motivational interviewing, health literacy, medication reconciliation, safety, therapeutic communication, advanced care planning)

- Population health initiatives (eg, screenings/risk stratifications, risk-reduction strategies, health equity, social drivers/determinants of health)

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