The Basics

CM 5 sets forth minimum qualifications for case managers.  Presented in the alternative, those qualification requirements are health-related bachelors' degree plus applicable licensure, or CM certification, or a license as an RN plus 3 years experience in clinical practice.  In addition to meeting one of these requirements, the case manager must perform his/her duties as a case manager within the scope of any license that they have.

The three years' experience required in one of the alternatives in this standard is measured in FTEs, so if you've got six years of half-time experience, that will count.

Management Tip

Note that most states won't allow an LPN to do CM assessment, so this might be one example of practice outside the scope of licensure.  If you've got LPNs doing case management, check your state law on this issue.

URAC Accreditation Tips

Documentation for desktop review is a combination of job descriptions, a P&P that incorporates the requirements of this standard, and a list of your case managers, along with the credentials for each that allow them to be case managers under this standard.

For the onsite review, the URAC reviewer not only will examine some of your case managers' personnel files for compliance with this standard, but also will want to see attestations from each case manager that they are practicing within the scope of their licensure.  The reviewer also will verify this standard through interviews of the case management supervisor and some of the case managers themselves.