Case Manager Skills Checklist

GENERAL Proficiency Frequency

Admission

1

2

3

4

1

2

3

4

Advance Directives

1

2

3

4

1

2

3

4

Collect Appropriate Data

1

2

3

4

1

2

3

4

Discharge Teaching

1

2

3

4

1

2

3

4

Organ/Tissue Donation

1

2

3

4

1

2

3

4

Patient and Family Teaching

1

2

3

4

1

2

3

4

Managed Care

1

2

3

4

1

2

3

4

Medicaid

1

2

3

4

1

2

3

4

Discharge Planning

1

2

3

4

1

2

3

4

Nursing Home Placement

1

2

3

4

1

2

3

4

Chart Review and Financial Audit

1

2

3

4

1

2

3

4

Conservatorship

1

2

3

4

1

2

3

4

Adult Protective Services

1

2

3

4

1

2

3

4

Child Protective Services

1

2

3

4

1

2

3

4

Hospice Referrals

1

2

3

4

1

2

3

4

Palliative Care Referrals

1

2

3

4

1

2

3

4

Chronic Disease Management

1

2

3

4

1

2

3

4

Home Health Referrals

1

2

3

4

1

2

3

4

DME

1

2

3

4

1

2

3

4

Computerized Documentation

1

2

3

4

1

2

3

4

Cardiovascular Patient Experience

Acute MI

1

2

3

4

1

2

3

4

Angina

1

2

3

4

1

2

3

4

Cardiomyopathy

1

2

3

4

1

2

3

4

Cardiopulmonary Arrest

1

2

3

4

1

2

3

4

Congestive Heart Failure

1

2

3

4

1

2

3

4

Heart Transplant

1

2

3

4

1

2

3

4

Pulmonary Patient Experience

COPD

1

2

3

4

1

2

3

4

Lung Transplant

1

2

3

4

1

2

3

4

Neurological Patient Experience

Acute Head Injury

1

2

3

4

1

2

3

4

Alzheimer's Disease

1

2

3

4

1

2

3

4

Coma

1

2

3

4

1

2

3

4

CVA

1

2

3

4

1

2

3

4

Multiple Sclerosis

1

2

3

4

1

2

3

4

Neuromuscular Disease

1

2

3

4

1

2

3

4

Spinal Cord Injury

1

2

3

4

1

2

3

4

Gastrointestinal Patient Experience

Abdominal Wounds and Surgeries

1

2

3

4

1

2

3

4

Colostomy

1

2

3

4

1

2

3

4

Hepatitis

1

2

3

4

1

2

3

4

Liver Failure

1

2

3

4

1

2

3

4

Liver Transplant

1

2

3

4

1

2

3

4

Pancreatitis

1

2

3

4

1

2

3

4

Liver Cancer

1

2

3

4

1

2

3

4

Pancreatic Cancer

1

2

3

4

1

2

3

4

Renal/Genitourinary Patient Experience

Acute Renal Failure

1

2

3

4

1

2

3

4

End Stage Renal Disease

1

2

3

4

1

2

3

4

Hemodialysis

1

2

3

4

1

2

3

4

Peritoneal Dialysis

1

2

3

4

1

2

3

4

Renal Transplant

1

2

3

4

1

2

3

4

Endocrine/Metabolic Patient Experience

Diabetics

1

2

3

4

1

2

3

4

Musculoskeletal Patient Experience

Amputation

1

2

3

4

1

2

3

4

Multiple Trauma

1

2

3

4

1

2

3

4

Vac-pac positioner

1

2

3

4

1

2

3

4

Paraplegia

1

2

3

4

1

2

3

4

Immunology/Hematology/Oncology Patient Experience

Cancer

1

2

3

4

1

2

3

4

HIV/AIDS

1

2

3

4

1

2

3

4

Sickle Cell Anemia

1

2

3

4

1

2

3

4

Acute Leukemia

1

2

3

4

1

2

3

4

Treatment Side Effects

1

2

3

4

1

2

3

4

Chemo/Radiation

1

2

3

4

1

2

3

4

Wounds/Integument Patient Experience

Burns

1

2

3

4

1

2

3

4

Pressure Sores

1

2

3

4

1

2

3

4

Staged Decubitus

1

2

3

4

1

2

3

4

Ulcers

1

2

3

4

1

2

3

4

Medications/Therapeutic Interventions

Medications Administration

Patient and Family Teaching

1

2

3

4

1

2

3

4

Oxygen Administration

Portable Oxygen

1

2

3

4

1

2

3

4

Home Oxygen

1

2

3

4

1

2

3

4

Pain Management

Assess PainLevel/Tolerance

1

2

3

4

1

2

3

4

Chronic PainManagement

1

2

3

4

1

2

3

4

Age Group Experience

0 - 30 Days

1

2

3

4

1

2

3

4

30 Days - 1 Year

1

2

3

4

1

2

3

4

1 - 3 Years

1

2

3

4

1

2

3

4

3 - 5 Years

1

2

3

4

1

2

3

4

5 - 12 Years

1

2

3

4

1

2

3

4

12 - 18 Years

1

2

3

4

1

2

3

4

18 - 39 Years

1

2

3

4

1

2

3

4

39 - 64 Years

1

2

3

4

1

2

3

4

64+ Years

1

2

3

4

1

2

3

4

Clinical Settings

Acute Care

1

2

3

4

1

2

3

4

Oncology

1

2

3

4

1

2

3

4

Clinic

1

2

3

4

1

2

3

4

Home Health

1

2

3

4

1

2

3

4

Long Term Care

1

2

3

4

1

2

3

4

LTAC

1

2

3

4

1

2

3

4

Rehab

1

2

3

4

1

2

3

4

SNU

1

2

3

4

1

2

3

4

Hospice

1

2

3

4

1

2

3

4

Insurance Company

1

2

3

4

1

2

3

4

Do you speak any languages other than English?

Yes

No

If yes, which language(s)?

Age Specific Skills

Check the box under EACH age group that you have experience with and are comfortable with for each skill below.

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different communication needs for the age group & changes communication methods and terminology accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different medications, dosages and possible side effects for the age group and administers medications appropriately

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the different safety risks for the age group and alters the environment accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

Understands the normal growth and development for the age group and adapts care accordingly

Neonates(0-30 days)

Infants(1 mo-1 yr)

Toddlers(1-3 yrs)

Preschool(4-6 yrs)

School Age(7-12 yrs)

Adolescent(13-18 yrs)

Young Adult(19-39 yrs)

Middle Adults(40-64 yrs)

Older Adults(65+ yrs)

*

I hereby certify that ALL information I have provided to Clover Health Services, on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Proficiency : -	1 = Never Performanced	2 = Limited Experience	3 = Comfortable Performing	4 = Proficient
Frequency : -	1 = Never	2 = Sometimes	3 = Often	4 = Always