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CM 500 – Theory and Process I


This course is an intermediate course for the program and provides a comprehensive learning program for theory, structure and practice application of case management. The course utilizes a most authoritative textbook in the specialty of case management and presents all facets of the practice. You receive comprehensive education in the professional practice of case management including systems, reimbursements, legal issues, and professional practice issues. Students focus on case management as a care delivery system that is multidisciplinary with outcomes focused management. Students receive a comprehensive review of the theory, process and practice of case management. The utilization review process is presented as well as tool for its practice. Students also begin the study of reimbursement systems, including Medicare and Medicaid, managed care and commercial carriers. This is the first course in the study of the theory and process of case management. Course Code: CM 500. Contact hours of education = 25.

This course is particularly designed for those who would like to apply for Fellowship certification as a “Fellow” in the American Academy of Case Management.

BOARD APPROVALS:  The American Institute of Health Care Professionals (The Provider) is approved by the California Board of Registered Nurses, Provider number # CEP 15595 for 25 Contact Hours. Access information

This course, which is approved by the Florida State Board Of Nursing (CE Provider # 50-11975) also has the following Board of Nursing Approvals, for 25 contact hours of CE

The American Institute of Health Care Professionals Inc: is a Rule Approved Provider of Continuing Education by the Arkansas Board of Nursing. CE Provider # 50-11975.
The American Institute of Health Care Professionals Inc: is a Rule Approved Provider of Continuing Education by the Georgia Board of Nursing. CE Provider # 50-11975.
The American Institute of Health Care Professionals Inc: is a Rule Approved Provider of Continuing Education by the South Carolina Board of Nursing. CE Provider # 50-11975.
The American Institute of Health Care Professionals Inc: is a Rule Approved Provider of Continuing Education by the West Virginia Board of Examiners for Professional Registered Nurses. CE Provider # 50-11975.
The American Institute of Health Care Professionals Inc: is a Rule Approved Provider of Continuing Education by the New Mexico Board of Nursing. CE Provider # 50-11975.

Course Refund & AIHCP Policies: access here

This is a guided, independent study CEU Course. You are to study and progress at your own rate. There are no written assignments. It is recommended that you follow this process for completing the course:

Instructor/Course Author:  Dominick L. Flarey, Ph.D, MBA, RN,BC, CNAA, FACHE

Link to Resume


TIME FRAME: You are allotted two years from the date of enrollment, to complete all of the courses in this continuing education program (all five (5) courses). There are no set time-frames per course, other than the two year allotted time. If you do not complete the courses within the two-year time-frame, you will be removed from the course and an “incomplete” will be recorded for you in our records. Also, if you would like to complete the courses after this two-year expiration time, you would need to register and pay the course tuition fee again.


Case Management: A Practical Guide for Education and Practice, 4th edition, by Suzanne K. Powell & Hussein A. Tahan. Philadelphia: Lippincott, Williams & Wilkins, 2018.

  • ISBN-10: 1496384253
  • ISBN-13: 978-1496384256

Link to Purchase on click here

GRADING: You must achieve a passing score of at least 70% to complete this course and receive the 25 hours of awarded continuing education credit. There are no letter grades assigned. You will receive notice of your total % score. Those who score below the minimum of 70% will be contacted by the American Academy of Case Management and options for completing additional course work to achieve a passing score, will be presented.


* Examination Access: there is link to take you right to the online examination program where you can print out your examination and work with it. All examinations are formatted as “open book” tests. When you are ready, you can access the exam program at anytime and click in your responses to the questions. Full information is provided in the online classrooms.

Student Resource Center: there is a link for access to a web page “Student Resource Center.” The Resource Center provides for easy access to all of our policies/procedures and additional information regarding applying for certification. We also have many links to many outside reference sites, such as online libraries that you may freely access.

* Online Evaluation: there is a link in the classroom where you may access the course evaluation. All students completing a course, must, without exception, complete the course evaluation.

* Faculty Access Information: you will have access to your instructor’s online resume/biography, as well as your instructor’s specific contact information.

* Additional Learning Materials: some faculty have prepared additional “readings” and /or brief lecture notes to enhance your experience. All of these are available in the online classrooms.




1. Discuss the concept and theories of case management systems and operations in health care.
2. Define case management responsibilities in over all care delivery.
3. Define and discuss the essential skills for case managers today.
4. Review and discuss issues related to credentialing
5. Understand and discuss the various case management tools in use, including guidelines.
6. Review and discuss standards of care and practice for case management.
7. Review insurance plans, both government and private and how they impact care delivery.
8. Define and discuss the process and applications of utilization management.
9. Understand the multiple legal issues related to case management practice.
10. Begin to conceptualize and discuss the application of case management theory and structure to actual professional case management practice in health care settings.
11. Identify and discuss the common legal issues related to the practice of case management and liability issues of case managers.
12. Review and discuss legislation and other regulatory issues that affect and impact case management care delivery.



1. Case management systems
2. Role of the case manager
3. Code of professional conduct
4. Models of case management
5. Disease management
6. Evaluation of case management models
7. International case management
8. Case management job responsibilities
9. Goals of case management
10. Essential skills for case managers
11. Patient advocacy
12. Multidisciplinary teams
13. Basic vs advanced skills
14. Practice guidelines
15. Standards of practice
16. Quality of care organizations
17. Regulatory agencies
18. Case management organization standards
19. NCQA and HEDIS
20. Reimbursement systems
21. Insurance models and systems
22. Medicare/Medicaid
23. Medicare managed care
24. Worker’s compensation
25. Managed health care systems and models
26. Utilization Management
27. Telephonic case management
28. Utilization modalities
29. Tools for utilization management
30. Clinical pathways
31. Documentation and communication
32. Legal issues in case management