Case management credentials: What you must know before taking the plunge
Case management credentials: What you must know before taking the plunge
How to make sense of the alphabet soup of CM certification
The volatile and often contentious industry of case management credentialing is set for a feeding frenzy in 1998 as certification organizations old and new jockey for your credentialing dollars. And with many hospitals now requiring certification as a condition of employment, there’s more urgency than ever for case managers to make sense of the credentials available to them.
Next year alone, more than 16,000 holders of the Certified Case Manager (CCM) credential will have to verify completion of 80 hours of approved continuing education to avoid having to retake the $290 exam. The Rolling Meadows, IL-based Commission for Case Manager Certification, which administers the credential, estimates that about 20% of those 16,000 won’t earn recertification about 3,200 case managers.
Meanwhile, the Washington, DC-based American Nurses Credentialing Center (ANCC) is busy retooling its still-unnamed nursing case management credential in light of its trouble-plagued fall pilot test. And other credentialing organizations are waiting in the wings, eager to accommodate the growing number of case managers who consider a credential vital to their survival in an increasingly competitive job market.
Professionals confused over credentials
"There’s a lot of overlap [in case management credentialing]," acknowledges Janet L. Maronde, RN, CPHQ, executive director of the San Gabriel, CA-based Healthcare Quality Certification board, which oversees the Certified Professional in Healthcare Quality (CPHQ) program. "The consumer is confused and our own certificate population is confused about what credentials to get. There’s a proliferation of certifications, frankly because there’s money to be made. It’s a difficult issue."
The controversy over case management credentialing dates back to 1993, when the CCM was established. The Commission for Case Manager Certification decided that anyone who met minimum eligibility requirements and sat for the CCM exam that year would receive the credential, regardless of whether they passed or failed. In other words, the 16,264 initial holders of the CCM credential, all of them now coming up for recertification, were effectively "grandfathered in." That means that, of the approximately 22,000 current CCMs, almost 75% "never actually met any standards," Maronde says. "If you assume a normal 70% pass rate, or even an 80% pass rate, that’s still quite a large percentage of people who, under normal conditions, would be considered unqualified."
Eda Holt, chief executive officer of the CCM program, defends the practice of grandfathering in early applicants by saying it’s necessary in order to establish baseline standards for testing future applicants. "It sets the norm for everybody else when you set the pass-and-fail [rate]. You have to norm it on the population." She adds that, since 1993, the average pass rate for the CCM exam has ranged between 80% and 85%.
The ANCC has been having problems of its own in establishing its new credential for nurse case managers. Of the 500 case managers who applied to take the October 1997 exam, a large percentage, possibly as high as 40%, failed to meet ANCC’s stringent and, some say, vague eligibility requirements. (See related story, p. 212.)
Recognizing the confusion among case managers over the variety of credentials available, representatives from the major credentialing bodies recently held a private summit in Chicago to discuss setting standard eligibility requirements. Organized by the Commission for Case Manager Certification, the summit was designed to establish "how we can communicate, collaborate, and move ourselves forward to assure a better health care delivery system with care and case management," says Holt.
Martha Koen, RN, MSN, vice president of the National Institute for Case Management and a member of ANCC’s case management Test Development Committee, attended the summit.
"I commend Eda and her people for organizing it," she says. "Because it seems like there are a lot of people out there just creating these credentials. And it’s confusing for the worker to know what to go after. One particular group put together a credential where the only requirement was that you be a high school graduate, whereas for the rehab counselor certification, the requirement is a master’s degree. So you have a huge array of eligibility criteria that I think dilutes the value of it."
High school isn’t such a high standard
Koen adds that she had hoped that the organizations participating in the summit would make strides in establishing a set of standard minimum requirements. "But the minimum requirements that we started discussing all they did was include what was already there," she says. "So, high school was minimum. And to me, that’s not going after a high standard."
Nevertheless, experts agree that having the right credential can add luster to a case manager’s résumé. "A credential can say to the public, the stakeholders, the payers, the employers, that you are a professional," Holt says. "You have met national standards, and are at least minimally competent in this area of expertise."
It also establishes your interest in and commitment to the discipline of case management, adds Jackie Somerville, RN, MS, a senior consultant for the South Natick, MA-based Center for Case Management, which is set to unveil its new credential for directors of case management this month. "One of the things you look for in a case manager is obviously a self-directed person, someone that’s really autonomous and is going to be able to be self-managing. So the fact that you’ve gone out there and sought out the certification and taken the exam is some indication that, OK, this is someone who is looking at their own development."
Somerville adds that the process of preparing to take a credentialing exam can help force case managers to take a broader look at the role they play in health care, which is essential if they wish to climb their system’s corporate ladder. There also can be benefits in terms of networking with others who share your credential, she says.
Examine body of knowledge being tested
So which credential should you choose? It depends on who you are and what case management means in your institution, experts say. "The definition of case management varies widely from facility to facility in terms of what you’re expected to do," says Maronde. "Some case managers are strictly discharge planners. Some places refer to them as case managers when they are nurses on the unit who are managing the 24-hour care of a patient. Some case managers are expected to have a caseload like under a managed care program, where they are in contact with the patient prehospitalization, during, and after."
In light of the differing definitions of case management, Maronde recommends that case managers "take a very close look at the body of knowledge that’s being tested, because everybody has to publish their content outline. And the more detailed it is, the better. And look at the tasks and the subjects being covered and compare that to the job you want to get or already have. Then decide which one is close to what you want to do and what you want to be." (For a description of the eligibility requirements and content outlines of the major case management credentials, see p. 215.)
Holt recommends discussing credentialing issues with your employer before making a final decision. "If I’m working in a big rehab hospital, I would probably look in terms of the CRRN, the certified clinical rehab nurse, because that exam is geared toward that content, that work setting," she says. "If I was working in a specialty and was only going to be doing oncology, I would look to the specialization organization that gives me a certification as a case manager in oncology. If I wanted to be a case manager and show that I’m certified in a broad, multidisciplinary certification process, then I would look toward this organization [the CCM]." (See related story on what employers want, p. 213.)
In endorsing her own credential, Maronde cites the CPHQ’s broad-based focus on quality as a major selling point. "A lot of the other certifications are more specific to a particular role," she says. "CPHQs, if they pass our exam, have enough information about all of the related areas so that they can see the bigger picture and how things fit together. So it’s valuable in terms of upward mobility. If you’re a case manager certified, then that’s what you do, is be a case manager. If you direct a quality management department and you aspire to move on to director of operations or something, [the CPHQ] is the more comprehensive credential."
As Maronde points out, however, it’s important to remember that while some hospitals are beginning to require a case management credential, there’s no law requiring you to become certified.
Koen, a former director of case management who doesn’t hold a case management credential, says, "I’m not a person who needed a credential to do my job. But some people have that need. I don’t know if it’s women or nurses or what, but some people have a need to belong to a group. I think it’s too early in the case management process to say, this is the best one or the better one or the one you ought to have. You get different opinions from the different camps, but everyone needs to make an individual choice based on their career goals and where they need or plan to go."
For more about case management credentials, see contact information, p. 215.
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