Question 1
A managed care nurse explains an HMO and PPO to a member. Which statement is accurate?
Show answer & explanation
Correct answer: A - An HMO generally uses a defined network and coordinated care structure
10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The CMCN exam has 200 questions and runs 4 hours.
These 10 free CMCN questions are organized by exam domain, so you can see how each part of the Certified Managed Care Nurse blueprint is tested. Reveal the answer and explanation under each question.
A managed care nurse explains an HMO and PPO to a member. Which statement is accurate?
Correct answer: A - An HMO generally uses a defined network and coordinated care structure
Which statement best describes government managed care products?
Correct answer: A - They serve eligible populations under federal or state programs and may use managed care models
A health plan pays a provider a fixed amount per member per month regardless of services used. Which reimbursement method is this?
Correct answer: A - Capitation
A managed care dashboard combines claims and clinical data to identify high-risk members. Its primary purpose is to:
Correct answer: A - Support data-informed care management
A utilization management nurse reviews an elective procedure before it occurs. Which UM activity is being performed?
Correct answer: A - Prospective review
A provider profile will be used to compare practice patterns. Which factor is essential before using the results?
Correct answer: A - Reliability of the measurement method
Which finding best shows a quality improvement intervention improved care?
Correct answer: A - Reduced unnecessary utilization while maintaining or improving outcomes
A disease management program is evaluated. Which result best demonstrates success?
Correct answer: A - Improved outcomes with appropriate resource use
A nurse discovers inaccurate information that may cause an improper payment. What is the appropriate compliance action?
Correct answer: A - Follow organizational compliance and reporting procedures
A member disagrees with a coverage decision and requests formal review. Which process applies?
Correct answer: A - Appeal or grievance process
The full bank has 1,020 more CMCN questions with explanations.
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