Case Analysis & Practical Application Flashcards

A case manager is transitioning a patient from hospital to home. The patient's spouse calls saying they cannot cope with the care demands. The MOST appropriate action is to:

Answer: Reassess the discharge plan and explore additional community supports

A spouse's inability to manage care demands requires reassessment to ensure a safe and sustainable discharge plan.

A case manager discovers that a client's housing is substandard and contributing to repeated respiratory infections. The PRIORITY response is to:

Answer: Advocate for the client by connecting them to housing assistance programs

Housing is a social determinant of health; advocacy and linkage to resources addresses the root environmental cause.

A case manager's client discloses during a home visit that they are experiencing domestic violence. The FIRST action is to:

Answer: Ensure the client's immediate safety and provide information about resources

Ensuring immediate safety and providing non-coercive resource information is the evidence-based first response to disclosed domestic violence.

An insurer denies a recommended inpatient rehabilitation stay for a stroke patient. The case manager believes the denial is inappropriate. The BEST next step is to:

Answer: Initiate a peer-to-peer review or formal appeal with supporting clinical documentation

A peer-to-peer review or formal appeal with clinical evidence is the appropriate first-line response to an inappropriate denial.

A case manager is working with a patient who has poorly controlled hypertension and reports high salt intake. The MOST effective educational approach is to:

Answer: Use motivational interviewing to explore the patient's readiness to change dietary habits

Motivational interviewing builds intrinsic motivation for behavior change, making it more effective than prescriptive or fear-based approaches.

A case manager completing a comprehensive assessment notes a patient scores 18 on the PHQ-9. The MOST appropriate action is to:

Answer: Inform the treating provider and coordinate a behavioral health referral

A PHQ-9 score of 18 indicates moderately severe depression and warrants immediate provider notification and behavioral health referral.

A case manager reviews claims data and identifies a high-cost member with no primary care visits in 18 months but multiple specialist visits. The BEST case management strategy is to:

Answer: Reach out to the member to establish a primary care relationship and coordinate care

Establishing a primary care home ensures coordinated, preventive care and reduces fragmented, high-cost specialist-driven utilization.