Skills Checklist – Case Manager

Skills Checklist – Case Manager

• Name
  
  First
  
  Last
• Phone
• Email
  
• ASSESSMENT/PATIENT CARE – GENERAL*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Admission
  Advance Directives
  Collect Appropriate Data
  Discharge Teaching
  Organ/Tissue Donation
  Patient and Family Teaching
  Managed Care
  Insurance Case Management
  Workman’s Comp
  Medicare
  Medicaid
  Discharge Planning
  Nursing Home Placement
  Chart Review and Financial Audit
  Conservatorship
  Adult Protective Services
  Child Protective Services
  Hospice Referrals
  Palliative Care Referrals
  Chronic Disease Management
  Home Health Referrals
  DME

• ASSESSMENT/PATIENT CARE – COMPUTERIZED DOCUMENTATION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Computerized
  Documentation

• ASSESSMENT/PATIENT CARE – CARDIOVASCULAR
  PATIENT EXPERIENCE*

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Acute MI
  Angina
  Cardiomyopathy
  Cardiopulmonary Arrest
  Congestive Heart Failure
  Heart Transplant

• ASSESSMENT/PATIENT CARE – PULMONARY PATIENT EXPERIENCE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  COPD
  Lung Transplant

• ASSESSMENT/PATIENT CARE – NEUROLOGICAL PATIENT EXPERIENCE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Acute Head Injury
  Alzheimer’s Disease
  Coma
  CVA
  Multiple Sclerosis
  Neuromuscular Disease
  Spinal Cord Injury

• ASSESSMENT/PATIENT CARE – GASTROINTESTINAL PATIENT EXPERIENCE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Abdominal Wounds and Surgeries
  Colostomy
  Hepatitis
  Liver Failure
  Liver Transplant
  Pancreatitis
  Liver Cancer
  Pancreatic Cancer

• ASSESSMENT/PATIENT CARE – RENAL/GENITOURINARY PATIENT EXPERIENCE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Acute Renal Failure
  End Stage Renal Disease
  Hemodialysis
  Peritoneal Dialysis
  Renal Transplant
  Case Manager Check List

• ASSESSMENT/PATIENT CARE – ENDOCRINE/METABOLIC PATIENT EXPERIENCE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Diabetics

• ASSESSMENT/PATIENT CARE – MUSCULOSKELETAL PATIENT EXPERIENCE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Amputation
  Multiple Trauma
  Paraplegia

• ASSESSMENT/PATIENT CARE – IMMUNOLOGY/HEMATOLOGY/ONCOLOGY PATIENT EXPERIENCE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Cancer
  HIV/AIDS
  Sickle Cell Anemia
  Acute Leukemia
  Treatment Side Effects Chemo/Radiation

• ASSESSMENT/PATIENT CARE -WOUNDS/INTEGUMENT PATIENT EXPERIENCE*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Burns
  Pressure Sores
  Staged Decubitus
  Ulcers

• MEDICATIONS/THERAPEUTIC INTERVENTIONS – MEDICATIONS ADMINISTRATION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Patient and Family Teaching

• MEDICATIONS/THERAPEUTIC INTERVENTIONS – OXYGEN ADMINISTRATION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Portable Oxygen
  Home Oxygen

• MEDICATIONS/THERAPEUTIC INTERVENTIONS – PAIN ADMINISTRATION*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Assess Pain Level/Tolerance
  Chronic Pain Management

• Do you speak any languages other than English?*
  • No

  If yes, enter languages above, separated by commas.

• Age Group Experience*
  

  	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
  Newborn (birth – 30 days)
  Infant (30 days – 1 year)
  Toddler (1 – 3 years)
  Preschooler (3 – 5 years)
  School Age (5 – 12 years)
  Adolescents (12 – 18 years)
  Young Adults (18 – 39 years)
  Middle Adults (39-64 years)
  Older Adults (64+ years)

• Confirmation*
  • 
    I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education.
• Signature
• Date
  
  Date Format: MM slash DD slash YYYY