Case Management Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security Number Email(Required) HiddenDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlySettingsAcute Care(Required) 1 2 3 4 Skilled/LTAC(Required) 1 2 3 4 MDS Coordinator(Required) 1 2 3 4 Home Health(Required) 1 2 3 4 Telephonic(Required) 1 2 3 4 Workers Compensation(Required) 1 2 3 4 Insurance(Required) 1 2 3 4 Managed Care(Required) 1 2 3 4 Acute Rehab(Required) 1 2 3 4 CM/UR SoftwareInterqual(Required) 1 2 3 4 Milliman(Required) 1 2 3 4 MIDAS(Required) 1 2 3 4 Allscripts UR(Required) 1 2 3 4 Word Processing Software(Required) 1 2 3 4 Other Software RegulatoryCMS/Medicare(Required) 1 2 3 4 HEDIS Measures(Required) 1 2 3 4 Blood Flow Rate(Required) 1 2 3 4 Core Measures(Required) 1 2 3 4 Medicaid/Medical(Required) 1 2 3 4 DRG(Required) 1 2 3 4 ICD 9 Coding(Required) 1 2 3 4 ICD 10 Coding(Required) 1 2 3 4 CPT(Required) 1 2 3 4 ProcessessBenefits Eligibility(Required) 1 2 3 4 Pre-Certification Review(Required) 1 2 3 4 Review for Admission Criteria(Required) 1 2 3 4 Identify Appropriate Level of Care(Required) 1 2 3 4 Review Status During Stay(Required) 1 2 3 4 Discharge Planning(Required) 1 2 3 4 Physician Advisor(Required) 1 2 3 4 Clinical Documentation Improvement(Required) 1 2 3 4 Needs Assessment/Order DME(Required) 1 2 3 4 Needs Assessment/Home Health(Required) 1 2 3 4 Needs Assessment/Hospice(Required) 1 2 3 4 Needs Assessment/Skilled(Required) 1 2 3 4 Third Party Authorization Process(Required) 1 2 3 4 Concurrent Review(Required) 1 2 3 4 Retrospective Review(Required) 1 2 3 4 Professional Knowledge & SkillsNational Patient Safety Goals(Required) 1 2 3 4 Age Specific/Population Based Care(Required) 1 2 3 4 Age Specific CompetenciesInfant (Birth - 1 year)(Required) 1 2 3 4 Preschooler (ages 2-5 years)(Required) 1 2 3 4 Childhood (ages 6-12 years)(Required) 1 2 3 4 Adolescents (ages 13-21 years)(Required) 1 2 3 4 Young Adults (ages 22-39 years)(Required) 1 2 3 4 Adults (ages 40-64 years)(Required) 1 2 3 4 Older Adults (ages 65-79 years)(Required) 1 2 3 4 Elderly (ages 80+ years)(Required) 1 2 3 4 EMREpic(Required) 1 2 3 4 Cerner(Required) 1 2 3 4 Eclipsys(Required) 1 2 3 4 McKesson(Required) 1 2 3 4 Meditech(Required) 1 2 3 4 Allscripts(Required) 1 2 3 4 Other: Specify EMR Conversion(Required) Yes No CertificationsBLS(Required) Yes No BLS Expiration Date Month Day Year Certified Case Manager (CCM)(Required) Yes No Certified Case Manager (CCM) Expiration Date Month Day Year Accredited Case Manager (ACM)(Required) Yes No Accredited Case Manager (ACM) Expiration Date Month Day Year Certified Disability Management Specialist (CDMS)(Required) Yes No Certified Disability Management Specialist (CDMS) Expiration Date Month Day Year Certified Clinical Documentation Specialist (CCDS)(Required) Yes No Certified Clinical Documentation Specialist (CCDS) Expiration Date Month Day Year ACLS(Required) Yes No ACLS Expiration Date Month Day Year Other: Please note any ICD 10 training(Required) Other Expiration Date Month Day Year Other: Specify(Required) Other Expiration Date Month Day Year AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. 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