CCM Ethical Principles and Conduct 2

Question 1

A case manager discovers that a client's employer-sponsored insurance plan is denying a medically necessary treatment. What is the case manager's primary ethical obligation?

Accepted Answer

Advocate for the client's right to medically necessary care

Answer

Advocacy is a core ethical duty of case managers, requiring them to actively support clients' access to medically necessary care.

Question 2

Which ethical principle is BEST reflected when a case manager ensures a client fully understands the risks and benefits of a proposed treatment before agreeing to it?

Accepted Answer

Autonomy

Answer

Respecting autonomy requires that clients receive complete information to make voluntary, informed decisions about their care.

Question 3

A case manager learns that a colleague is falsifying documentation to obtain insurance approvals. What should the case manager do FIRST?

Accepted Answer

Immediately report to the appropriate supervisory or regulatory authority

Answer

Falsifying documentation is fraud; the case manager's ethical and legal duty requires prompt reporting to appropriate authorities.

Question 4

When a case manager works for both a health plan and provides services to its members, which ethical issue is MOST likely to arise?

Accepted Answer

Conflict of interest

Answer

Serving both the payer and the client creates a conflict of interest, as the case manager's loyalties may be divided.

Question 5

A terminally ill client requests information about hospice care but family members ask the case manager to withhold this information. The case manager should:

Accepted Answer

Provide the client with the requested information, honoring their autonomy

Answer

A competent client's right to information about their own care supersedes family preferences under the autonomy principle.

CCM - Certified Case Manager Exam Practice Test

CCM - Certified Case Manager Exam Practice Test

CCM Ethical Principles and Conduct 2