Latest PDF of CMCN: ABMCN Certification in Managed Care Nursing

ABMCN Certification in Managed Care Nursing Practice Test

CMCN Exam Format | Course Contents | Course Outline | Exam Syllabus | Exam Objectives

100% Money Back Pass Guarantee

CMCN PDF Sample Questions

CMCN Sample Questions

Question: 1
Identify and define the multiple components of a utilization management program.
A. The multiple components of a utilization management program include preauthorization, concurrent review, retrospective review, and clinical guidelines.
B. The multiple components of a utilization management program include fee schedules, billing processes, reimbursement rates, and claims processing.
C. The multiple components of a utilization management program include patient education, health promotion activities, preventive screenings, and disease management programs.
D. The multiple components of a utilization management program include medical coding, health record documentation, compliance with regulations, and quality improvement initiatives.
Answer: A
Explanation: The multiple components of a utilization management program include: Pre-authorization: This involves obtaining approval before certain medical services or procedures are performed to ensure they meet specific criteria for medical necessity and appropriateness. Concurrent review: This involves ongoing monitoring of a patient's care while they are receiving treatment to ensure it remains necessary and appropriate. Retrospective review: This involves a review of medical records and claims after services have been provided to determine if they were medically necessary and appropriate. Clinical guidelines: These are evidence-based guidelines or protocols that provide recommendations for the appropriate utilization of healthcare services based on the best available evidence. These components work together to ensure that healthcare services are utilized appropriately, efficiently, and in accordance with established guidelines and standards.
Question: 2
Which of the following components are typically included in a utilization management program in managed care?
A. Quality improvement initiatives, performance measurement, and reporting.
B. Patient education, wellness programs, and preventive care.
C. Case management, disease management, and care coordination.
D. Prior authorization, concurrent review, and retrospective review.
Answer: D
Explanation: A utilization management program in managed care typically includes components such as prior authorization, concurrent review, and retrospective review. These processes help ensure appropriate utilization of healthcare resources, aligning with established guidelines and optimizing cost-effectiveness while maintaining quality of care.
Question: 3
Describe challenges medicine and nursing have overcome, changes in the current healthcare delivery system, and the implications for the future of nursing.
A. The challenges faced by medicine and nursing include maintaining quality care in the face of complex medical conditions, addressing healthcare disparities among different populations, and adapting to changing reimbursement models. These challenges have necessitated a greater emphasis on evidence-based practice and interdisciplinary collaboration.
B. The challenges faced by medicine and nursing include a shortage of healthcare professionals, limited access to care in underserved areas, and the rising cost of healthcare. These challenges have prompted a focus on preventive care and the integration of technology in healthcare delivery.
C. The challenges faced by medicine and nursing include advancements in technology, changing patient demographics, and evolving healthcare policies. These changes have led to a shift towards more patient-centered care and increased collaboration between healthcare professionals.
D. The challenges faced by medicine and nursing include the integration of electronic health records, ensuring patient privacy and data security, and effectively utilizing healthcare data for improved outcomes. These challenges have driven the need for health informatics and data analytics skills in nursing practice.
Answer: C
Explanation: Over the years, medicine and nursing have faced several challenges such as advancements in technology, changing patient demographics, and evolving healthcare policies. These challenges have led to a shift towards more patient-centered care, where the focus is on providing individualized care and involving patients in decision-making. Additionally, there has been an increased emphasis on interdisciplinary collaboration, with healthcare professionals working together to provide comprehensive care. These changes in the healthcare delivery system have significant implications for the future of nursing, including the need for nurses to possess strong communication and collaboration skills, adaptability to technological advancements, and a patient-centered mindset. Nurses will play a crucial role in coordinating care, managing chronic conditions, and promoting health and wellness in the evolving healthcare landscape.
Question: 4
Define individual's challenges for functioning in the future of healthcare.
A. Individuals in the future of healthcare will face challenges such as a decline in healthcare innovation, limited use of technology in healthcare settings, and a lack of interdisciplinary collaboration.
B. Individuals in the future of healthcare will face challenges such as a lack of access to healthcare services, limited availability of healthcare providers, and a decline in healthcare quality.
C. Individuals in the future of healthcare will face challenges such as a lack of emphasis on preventive care, a shortage of healthcare resources, and limited patient engagement.
D. Individuals in the future of healthcare will face challenges such as adapting to technological advancements, acquiring new skills to meet evolving healthcare demands, and navigating complex healthcare systems.
Answer: D
Explanation: Individuals functioning in the future of healthcare will encounter challenges related to adapting to technological advancements. This includes embracing electronic health records, telehealth, and other emerging technologies that will shape healthcare delivery. Additionally, individuals will need to acquire new skills to meet the evolving demands of healthcare, such as proficiency in health informatics and data analytics. Navigating complex healthcare systems and understanding the changing healthcare landscape will also present challenges. It will require individuals to be adaptable, lifelong learners, and effective collaborators in interdisciplinary healthcare teams.
Question: 5
Which of the following defines the trends currently impacting healthcare?
A. Fee-for-service reimbursement models.
B. Telehealth and remote patient monitoring.
C. Fragmented care delivery.
D. Independent physician practices.
Answer: B
Explanation: The trend of telehealth and remote patient monitoring is currently impacting healthcare. These technologies enable remote access to healthcare services, facilitate virtual consultations, and improve patient monitoring and management. Telehealth has the potential to increase access to care, improve patient outcomes, and reduce healthcare costs.
Question: 6
Describe a major challenge that medicine and nursing have overcome in the current healthcare delivery system and its implications for the future of nursing.
A. Implementation of quality improvement initiatives to reduce medical errors.
B. Adoption of evidence-based practice (EBP) to enhance patient outcomes and safety.
C. Integration of interdisciplinary teamwork to promote collaborative care.
D. Transition from paper-based records to electronic health records (EHRs) for improved care coordination.
Answer: D
Explanation: One major challenge that medicine and nursing have overcome in the current healthcare delivery system is the transition from paper-based records to electronic health records (EHRs). This shift has led to improved care coordination, streamlined communication, and enhanced accessibility to patient information. In the future, nursing professionals will need to be proficient in utilizing EHR systems to deliver efficient and patient-centered care.
Question: 7
Describe disease state management programs.
A. Disease state management programs aim to shift the responsibility of managing chronic conditions from healthcare providers to patients, promoting self-care and reducing healthcare utilization.
B. Disease state management programs focus on acute care interventions and medical treatments to address specific diseases or conditions.
C. Disease state management programs primarily rely on pharmacological interventions to manage chronic conditions and reduce symptom severity.
D. Disease state management programs are comprehensive, coordinated approaches to managing chronic conditions that involve patient education, self-management strategies, and regular monitoring to optimize health outcomes and reduce healthcare costs.
Answer: D
Explanation: Disease state management programs are comprehensive, coordinated approaches to managing chronic conditions. These programs involve various components such as patient education, self-management strategies, regular monitoring, and collaboration between healthcare providers and patients. The goal of disease state management programs is to optimize health outcomes and reduce healthcare costs associated with chronic conditions by promoting self-care, empowering patients to actively participate in their own healthcare, and providing the necessary tools and support for effective disease management. These programs often include interventions such as lifestyle modifications, medication management, and regular follow-up to ensure ongoing disease control and prevention of complications.
Question: 8
Define the trends currently impacting healthcare.
A. Some of the trends currently impacting healthcare include a shift towards fee-for-service reimbursement models, increased reliance on paper-based medical records, and limited use of technology in healthcare settings.
B. Some of the trends currently impacting healthcare include telemedicine, personalized medicine, and the integration of artificial intelligence and machine learning in healthcare delivery.
C. Some of the trends currently impacting healthcare include a focus on acute care settings, fragmented care delivery, and a lack of emphasis on preventive care.
D. Some of the trends currently impacting healthcare include a decline in patient engagement, limited access to healthcare services, and a lack of emphasis on quality improvement initiatives.
Answer: B
Explanation: Some of the trends currently impacting healthcare include telemedicine, which allows for remote patient consultations and enhances access to care, personalized medicine, which tailors treatment plans based on individual patient characteristics, and the integration of artificial intelligence and machine learning in healthcare delivery, which enables more accurate diagnostics and predictive analytics. These trends are reshaping the way healthcare is delivered, making it more patient-centered, efficient, and technologically advanced. They havethe potential to improve healthcare outcomes, increase access to care, and enhance the overall patient experience.
Question: 9
How does quality management impact the cost of care in managed care?
A. By promoting patient satisfaction and loyalty, resulting in increased revenue.
B. By implementing cost-containment measures that may compromise quality.
C. By increasing administrative overhead and expenses.
D. By reducing medical errors and adverse events, leading to cost savings.
Answer: D
Explanation: Quality management in managed care has a direct impact on the cost of care by reducing medical errors and adverse events, leading to cost savings. By implementing quality improvement initiatives, healthcare organizations can enhance patient safety, reduce unnecessary interventions, and avoid costly complications. This, in turn, helps to optimize resource utilization and improve overall cost-effectiveness in the delivery of care.
Question: 10
Describe disease state management programs in the context of managed care nursing.
A. Programs that focus on disease prevention and health promotion.
B. Programs that provide comprehensive care and support for patients with chronic conditions.
C. Programs that prioritize quality improvement initiatives.
D. Programs that facilitate care transitions and discharge planning.
Answer: B
Explanation: Disease state management programs in managed care nursing are designed to provide comprehensive care and support for patients with chronic conditions. These programs aim to optimize patient outcomes by offering education, self-management strategies, care coordination, and regular monitoring to effectively manage chronic diseases and preventcomplications. The goal is to enhance the patient's quality of life, promote self-care, and reduce healthcare utilization related to the chronic condition.
Question: 11
Which of the following principles is fundamental to health economics in managed care organizations?
A. Patient advocacy.
B. Risk management.
C. Cost-effectiveness analysis.
D. Evidence-based practice.
Answer: C
Explanation: Cost-effectiveness analysis is a fundamental principle in health economics for managed care organizations. It involves assessing the costs and benefits of different healthcare interventions or strategies to determine the most efficient allocation of resources. This analysis helps organizations make informed decisions regarding the allocation of funds and the delivery of cost-effective healthcare services.
Question: 12
What is the primary purpose of the negotiation process in managed care?
A. To establish mutually beneficial contracts between healthcare providers and payers.
B. To ensure patient satisfaction and loyalty.
C. To promote competition among healthcare organizations.
D. To reduce healthcare costs and increase profitability.
Answer: A Explanation: The primary purpose of the negotiation process in managed care is to establish mutually beneficial contracts between healthcare providers and payers. Through negotiation, providers and payers can agree on reimbursement rates, service coverage, and other contractual terms that ensure fair compensation for services rendered and facilitate the delivery of quality care to patients.
Question: 13
Explain the relationship between types of provider reimbursement.
A. Fee-for-Service (FFS) reimbursement is a fixed payment per patient over a specific period of time, while Capitation reimbursement is determined by the patient's health outcome.
B. Fee-for-Service (FFS) reimbursement is a fixed payment per patient over a specific period of time, while Capitation reimbursement is based on the number of services provided.
C. Fee-for-Service (FFS) reimbursement is based on the number of services provided, while Capitation reimbursement is a fixed payment per patient over a specific period of time.
D. Fee-for-Service (FFS) reimbursement is determined by the patient's health outcome, while Capitation reimbursement is based on the number of services provided.
Answer: C
Explanation: Fee-for-Service (FFS) reimbursement is a traditional payment model where healthcare providers are paid based on the number of services they provide. Capitation reimbursement, on the other hand, is a payment model where healthcare providers receive a fixed payment per patient over a specific period of time, regardless of the services provided. The relationship between the two types of reimbursement is that FFS is based on the quantity of services, while Capitation is based on a fixed payment per patient.
Question: 14
Understand health economics principles for managed care organizations.
A. Health economics principles for managed care organizations revolve around promoting competition among healthcare providers to drive down costs and improve quality of care.
B. Health economics principles for managed care organizations focus on maximizing profits through increased patient volume and reducing reimbursement rates for healthcare services.
C. Health economics principles for managed care organizations involve cost containment strategies, such as utilization management and preventive care, to achieve efficient and effective healthcare delivery.
D. Health economics principles for managed care organizations prioritize revenue generation through the utilization of advanced medical technologies and expensive treatment options.
Answer: C
Explanation: Health economics principles for managed care organizations are centered around cost containment strategies to achieve efficient and effective healthcare delivery. Managed care organizations work to control healthcare costs while maintaining or improving the quality of care. This involves various approaches such as utilization management, which aims to ensure appropriate utilization of healthcare services, and preventive care, which focuses on early intervention and disease prevention to reduce long-term costs. By implementing these principles, managed care organizations strive to provide cost-effective care and improve health outcomes for their members.
Question: 15
What are some challenges individuals may face in functioning within the future of healthcare?
A. Collaborating with interdisciplinary healthcare teams.
B. Managing complex and chronic medical conditions.
C. Navigating the complexities of insurance coverage and reimbursement.
D. Adapting to rapidly evolving technology and informatics.
Answer: D
Explanation: Some challenges individuals may face in functioning within the future of healthcare include adapting to rapidly evolving technology and informatics. As healthcare increasingly relies on digital systems, individuals will need to acquire and maintain proficiency in using technology for healthcare purposes. This includes electronic health records, telehealth platforms, and other digital tools that support care delivery and management.
Question: 16
Understand the concepts of the negotiation process.
A. The negotiation process involves asserting one's position forcefully and using power dynamics to achieve a favorable outcome.
B. The negotiation process involves identifying common interests, setting objectives, and engaging in a collaborative discussion to reach a mutually beneficial agreement.
C. The negotiation process relies on deception and manipulation tactics to gain an advantage over the other party.
D. The negotiation process is a one-sided decision-making process where one party imposes its terms on the other.
Answer: B
Explanation: The negotiation process involves identifying common interests, setting objectives, and engaging in a collaborative discussion to reach a mutually beneficial agreement. It is a constructive and interactive process where both parties involved work towards finding a solution that satisfies their interests. Effective negotiation requires active listening, effective communication, and the ability to identify shared goals and areas of compromise. It is a skill that is essential in various aspects of healthcare, such as contract negotiations, conflict resolution, and interprofessional collaboration.

Killexams VCE Exam Simulator 3.0.9

Download Killexams-Exam-Simulator-3.0.9.rar

Killexams has introduced Online Test Engine (OTE) that supports iPhone, iPad, Android, Windows and Mac. CMCN Online Testing system will helps you to study and practice using any device. Our OTE provide all features to help you memorize and practice test questions and answers while you are travelling or visiting somewhere. It is best to Practice CMCN Exam Questions so that you can answer all the questions asked in test center. Our Test Engine uses Questions and Answers from Actual ABMCN Certification in Managed Care Nursing exam.

Killexams Online Test Engine Test Screen

Killexams Online Test Engine Progress Chart

Killexams Online Test Engine Test History Graph

Killexams Online Test Engine Performance History

Killexams Online Test Engine Result Details

Online Test Engine maintains performance records, performance graphs, explanations and references (if provided). Automated test preparation makes much easy to cover complete pool of questions in fastest way possible. CMCN Test Engine is updated on daily basis.

CMCN Question Bank are daily updated at killexams.com

Our comprehensive CMCN Mock Questions includes a complete pool of CMCN questions and answers, carefully vetted and validated with references and explanations (where applicable). Our goal is not just to help you pass the ABMCN Certification in Managed Care Nursing test on the first attempt, but also to improve your overall knowledge of the CMCN test topics.

Latest 2024 Updated CMCN Real Exam Questions

Preparing for an important exam like the Nursing CMCN exam can be a daunting task, especially when you don't have access to reliable study materials. At killexams.com, we understand the importance of having accurate and updated exam questions and answers to help you pass your ABMCN Certification in Managed Care Nursing exam with ease. That's why we offer a free CMCN Mock Exam containing actual exam questions and answers to give you an idea of what to expect on the real test. Our free CMCN Mock Exam is carefully curated to include genuine test inquiries, providing you with the opportunity to test your knowledge and skills before taking the actual exam. By going through our free CMCN Mock Exam, you will have a better understanding of the types of questions you may encounter on the test day. This will help you to prepare more effectively and confidently, improving your chances of passing the Nursing CMCN exam on your first attempt. At killexams.com, we pride ourselves on offering comprehensive and updated CMCN Mock Exam to help our customers succeed in their exams. Our CMCN Mock Exam is regularly updated to ensure that you have access to the most current exam questions and answers. We understand that taking the Nursing CMCN exam can be stressful, which is why we want to make sure that you have the best study materials available to help you prepare.

Killexams Review | Reputation | Testimonials | Customer Feedback

I owe my success in the CMCN exam to killexams.com. The platform provided me with reliable material and helped me score high in the exam. I advise all students to rely on the best educational services provided by killexams.com for their exam preparation.
Shahid nazir [2024-5-8]

Following my friends' recommendation, I chose to prepare for the CMCN exam using killexams.com, and I am glad that I did. The Practice Tests were easy to use and well-organized, with the questions arranged in a manner that made them easy to memorize. Thanks to this, I passed the exam with an 89% mark.
Shahid nazir [2024-5-22]

In conclusion, killexams.com's Questions and Answers are the most ideal way to get equipped and pass IT tests. I got an 88% on my CMCN exam, and my associates have applied for many one-of-a-kind certificates using killexams.com's material. It is a completely solid learning tool and one of my top choices.
Martha nods [2024-6-22]

More CMCN testimonials...

CMCN Exam

User: Sarah*****

Killexams.com is a reliable and trustworthy resource with authentic CMCN questions and precise answers. The exam simulator works flawlessly, and with helpful customer support, it provides an incredibly desirable experience. I had a great experience and passed the exam with a high score, which is why I highly recommend Killexams.com.

User: Sarah*****

I would have never passed the cmcn exam without your exam prep materials. A few months ago, I failed the exam the first time I took it, but this time I was successful with ease. Your questions are very similar to the actual ones, which made it easy for me to understand and pass the exam. Thank you very much for your assistance.

User: Zigfrids*****

For those of you who are short on time and cannot memorize, do not worry. I was in a similar situation, but I found an easy solution with Killexams. Their questions and answers were very helpful and allowed me to grasp the concepts and memorize the difficult parts. The questions were identical to the guide, and I was able to score well. Thanks to Killexams for their useful material.

User: Louise*****

During my preparation for the CMCN exam, I faced a tough time seeking help from friends as the material I received was mostly unclear and overwhelming. However, I stumbled upon killexams.com and its Questions and Answers material, which proved to be a valuable resource. With the help of their material, I was able to understand all the concepts and answer all the questions in the practice test with precision, bringing endless happiness to my profession.

User: Zoya*****

I want to take the opportunity to thank all the crew members of killexams.com for creating such an exquisite platform for us. With the help of their online questions and cases, I easily passed my abmcn certification in managed care nursing certification with 81% marks. It was sincerely helpful to understand the type and patterns of questions and explanations provided for answers, which made my concepts crystal clear. Thank you for all of the guides, and keep up the good work, killexams.com.

CMCN Exam

Question: How much daily study is required to pass CMCN exam?
Answer: Usually, if you have a busy schedule, you need to spend two hours daily reading and practice CMCN test prep. If you are free and you have more time to study, you can prepare for an exam even in 24 hours. Although, we recommend taking your time to study and practice CMCN practice test until you are sure that you can answer all the questions that will be asked in the actual CMCN exam. For complete CMCN test prep, visit killexams.com and register to download the question bank of CMCN practice test. These CMCN exam questions are taken from actual exam sources, that's why these CMCN exam questions are sufficient to read and pass the exam. Although you can use other sources also for improvement of knowledge like textbooks and other aid material these CMCN questions are sufficient to pass the exam.

Question: I need an exam that is not at killexams store, what should I do?
Answer: Killexams provide more than 5500 exams on its online store with a very high success rate. If you need an exam that is not provided at the killexams store, you can place an exam request at killexams.com at https://killexams.com/exam-request and our team will contact authentic resources to get exact questions and answers. You will be informed by email as soon as that exam is provided at the killexams store.

Question: How long it will take to setup my killexams account?
Answer: Killexams take just 5 to 10 minutes to set up your online download account. It is an automatic process and completes in very little time. When you complete your payment, our system starts setting up your account within no time and it takes less than 5 minutes. You will receive an email with your login information immediately after your account is setup. You can then login and download your exam files.

Question: Does Killexams provide Medical Exams also?
Answer: Yes. Killexams provide medical, banking, finance, nursing, Information technology, engineering, and thousands of other exams. Just go to the search page at killexams.com and search for your career certification. Register and download the full version.

Question: Do I need updated and valid real CMCN exam questions to pass the exam?
Answer: Yes, sure. You need up-to-date CMCN questions to pass the exam. Killexams.com provides real CMCN exam questions and answers that appear in the actual CMCN exam. You should also practice these questions and answers with an exam simulator.

References

Frequently Asked Questions about Killexams Practice Tests

Will I be able to locate up-to-date CMCN exam TestPrep?
Yes, once registered at killexams.com you will be able to download up-to-date CMCN exam brainpractice questions that will help you pass the exam with good marks. When you download and practice the exam questions, you will be confident and feel improvement in your knowledge.

What will I do if I fail the CMCN exam?
First of all, if you read and memorize all CMCN practice questions and practice with the VCE exam simulator, you will surely pass your exam. But in case, you fail the exam you can get the new exam in replacement of the present exam or refund. You can further check details at https://killexams.com/pass-guarantee

Can I expect all the questions in actual test be from killexams CMCN question bank?
Killexams provide up-to-date actual CMCN test questions that are taken from the CMCN brainpractice questions. These questions\' answers are verified by experts before they are included in the CMCN question bank.

Is Killexams.com Legit?

Sure, Killexams is completely legit as well as fully efficient. There are several capabilities that makes killexams.com unique and authentic. It provides updated and 100% valid exam dumps formulated with real exams questions and answers. Price is very low as compared to almost all the services on internet. The questions and answers are current on frequent basis along with most recent brain dumps. Killexams account structure and device delivery is extremely fast. Data downloading will be unlimited and fast. Help is available via Livechat and E-mail. These are the features that makes killexams.com a sturdy website that supply exam dumps with real exams questions.

Other Sources

Which is the best testprep site of 2024?

There are several Questions and Answers provider in the market claiming that they provide Real Exam Questions, Braindumps, Practice Tests, Study Guides, cheat sheet and many other names, but most of them are re-sellers that do not update their contents frequently. Killexams.com is best website of Year 2024 that understands the issue candidates face when they spend their time studying obsolete contents taken from free pdf download sites or reseller sites. That is why killexams update Exam Questions and Answers with the same frequency as they are updated in Real Test. Testprep provided by killexams.com are Reliable, Up-to-date and validated by Certified Professionals. They maintain Question Bank of valid Questions that is kept up-to-date by checking update on daily basis.

If you want to Pass your Exam Fast with improvement in your knowledge about latest course contents and topics, We recommend to Download PDF Exam Questions from killexams.com and get ready for actual exam. When you feel that you should register for Premium Version, Just choose visit killexams.com and register, you will receive your Username/Password in your Email within 5 to 10 minutes. All the future updates and changes in Questions and Answers will be provided in your Download Account. You can download Premium Exam questions files as many times as you want, There is no limit.

Killexams.com has provided VCE Practice Test Software to Practice your Exam by Taking Test Frequently. It asks the Real Exam Questions and Marks Your Progress. You can take test as many times as you want. There is no limit. It will make your test prep very fast and effective. When you start getting 100% Marks with complete Pool of Questions, you will be ready to take Actual Test. Go register for Test in Test Center and Enjoy your Success.

100% Money Back Pass Guarantee

Back to List

Social Profiles

ABMCN Certification in Managed Care Nursing Practice Test

CMCN Exam Format | Course Contents | Course Outline | Exam Syllabus | Exam Objectives

100% Money Back Pass Guarantee

CMCN PDF Sample Questions

CMCN Sample Questions

Killexams VCE Exam Simulator 3.0.9

CMCN Question Bank are daily updated at killexams.com

Latest 2024 Updated CMCN Real Exam Questions

Tags

Killexams Review | Reputation | Testimonials | Customer Feedback

CMCN Exam

CMCN Exam

References

Frequently Asked Questions about Killexams Practice Tests

Is Killexams.com Legit?

Other Sources

Which is the best testprep site of 2024?

Important Links for best testprep material

100% Money Back Pass Guarantee

Social Profiles