About this Webinar Training

NCQA Essentials for Case Management

Through this course, participants will learn the fundamentals of case management from systematic evidence reviews through care transitions. Our experts dive deep into practical cases for working with interdisciplinary teams and ensuring patients receive timely and appropriate care.

Early Bird Rate: $855 Use code: CMJUNE25
Early Bird Rate Ends May 31, 2025

What You Will Learn

Course Topics

• Case Management Program Essentials
• Patient Identification and Assessment
• Care Planning
• Care Monitoring 
•  Care Transitions
• Measurement and Quality Improvement
• Staffing, Training, and Verification
• Member Rights and Responsibilities
• Delegation of Case Management

Learning Objectives for Case Management

• Use evidence-based information to develop and refine a case management program.

• Define activities for systematically identifying patients for the case management program.

• Recognize attributes of adequate individualized care plans.

• Recognize practices for effectively monitoring individualized care plans.

• Explore tactics for reducing unplanned transitions and identifying care transition issues.

• Define practices for measuring program effectiveness and improving patient experience.

• Discuss opportunities for preparing staff with clinical practice guidelines.

• Recognize practices for effectively communicating expectations to members enrolled within a case management program.

• Define structures for and mechanisms to oversee delegated case management activities.

 

Course Outcomes

After completing this course, learners will be able to:

• • Identity opportunities for enhancing their current utilization program.
  • Evaluate the effectiveness of their current utilization management program.
  • Recognize the changes necessary to improve a utilization management program.
  • Optimize coordination for delegation arrangements.                                                                                                                                                                

Who Should Attend

Clinicians, executives, managers, specialists, consultants, delegates, and vendors who are employed or contracted by health plans with responsibilities related to case management operations, including:

• Directors of Accreditation or Compliance
• Directors of Case Management
• Case Managers
• Population Health Managers
• Clinical Social Workers
• Care Coordination Managers
• Discharge Planners

Learning Materials and Resources

• Live Q&A with a case management expert
• Recording of live presentations
• Three (3) case studies
• Knowledge check quizzes
• Presentation Slides

Faculty

Clint Koenig, MD, MSPH, MA

Clint Koenig, MD, MA, MSPH is the Senior Medical Director at OhioHealthy, a new system-based health plan in Columbus, Ohio. He has served as State Medical Director in New Hampshire and Ohio. Other leadership roles include the Health Plan Regional Chief Medical Officer at Universal American, a government programs health management organization in Syracuse, New York, as well as, the Director for Utilization Management at Monroe Plan for Medical Care, a healthcare management organization in Rochester, New York. In addition, Clint held Chief Medical Officer roles in Federally Qualified Health Centers and integrated delivery systems.

He has been an NCQA surveyor for 10 years and surveys health plans, Patient Centered Medical Home, Special Needs Plans and Long Term Services and Supports organizations.

Dr. Koenig received his MD from Albany Medical College in Albany, New York. He completed his residency in Family Medicine, from the University of Missouri. He also completed a fellowship at the University of Missouri, where he received a master’s degree in Public Health and Journalism.

Bonus Material

Navigating NCQA Delegation (Self-paced)

Want to know what Delegation means to NCQA and familiarize yourself with the nuances? This virtual course can provide you with those answers and more. Experienced faculty will take a deep dive of each NCQA delegation standard, to improve your understanding, from oversight to automatic credit. You will learn how to navigate through examining key elements that should be in place prior to an organization's decision to give an entity the authority to act on their behalf. A demo of NCQA’s Interactive Review Tool (IRT) will also be provided.

What You Will Learn

At the conclusion of this event, learners will be able to:

• Explain NCQA’s Delegation Standards—including oversight requirements and criteria for automatic credit and file review
• Identify appropriate documentation and operational procedures required to comply with NCQA’s delegation requirements
• Describe potential areas of concern in the delegation process
• Apply NCQA’s Delegations Standards to assist healthcare organizations in the delegation process

Faculty

Candice Costello, BS

Veronica Locke, MHSA

Irv Koehler, RN, MBA, CPHQ, CPC

Continuing Education

Essentials for Case Management:

In support of improving patient care, the National Committee for Quality Assurance is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), the American Nurses Credentialing Center (ANCC) to provide Interprofessional Continuing Education for the healthcare team. 

This educational activity is approved for: 4.0 AMA PRA Category 1 Credit^TM , 4.0 ANA CNE contact hours and 4.0 ASWB contact hours.

This live webinar grants 4 Other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

• Please note – You must attend the entire program to be eligible for total number of contact hours.

 

Navigating Delegation: This is a non-accredited activity,

Disclosure of Relevant Financial Relationships

The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.

For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution.  For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.

Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Relevant financial relationships exist with the following companies/organizations:

Faculty:
Clint Koenig: None

Candice Costello: None

Veronica Locke: None

Irv Koehler: None

Additional Planning Committee Members:
Vince Pereira: None

 

This program was developed in part by NCQA staff.