The Case Management Administrator (CMAC) certification is recognized for five
years. ... date of the CMAC certificate is December 31st of the fifth year after ...
Guidelines for CMAC Recertification DURATION OF CERTIFICATION
The Case Management Administrator (CMAC) certification is recognized for five years. The expiration date of the CMAC certificate is December 31st of the fifth year after certification regardless of the month in which you wrote the examination (i.e., if the certification date was August 2011 then certification expires on December 31st, 2016. Prior to certificate expiration, you must obtain a CMAC Recertification Application Form. The form is enclosed with this letter and will be also available through the Professional Testing Corporation (PTC)* by written request or from their website. It is the responsibility of the CMAC to initiate the recertification process and to notify PTC or The Center for Case Management of any name or address change. The deadline for recertification submissions for each certified group will be identified in the application package and web site. Applications received after certification expiration will be denied. At this point, candidates will need to rewrite and pass the certification examination to maintain their CMAC.
Lapsed Certification If you do not recertify when the five-year term has ended, your CMAC certification is considered lapsed. To regain certification you must meet the eligibility criteria. Submit application for initial certification and write and pass the certification examination.
Application for recertification must be submitted at least 3 months prior to expiration date. Application Deadlines: September 30 th for December 31st Certification Expiration Keeping Track of Clock Hours Professionally and ethically you are the best judge of which clock hours apply toward recertification.
• Submit your list at the time of application for recertification. Directions: 1.
Use the form on page 3 to list the programs you have attended, the relevant CONTENT AREA that applies to each program, and the clock hours. The Content Area must be identified for each program you have included for clock hours.
2.
Provide a copy of the certificate of completion or other supporting documentation (such as transcripts for college course or course taught) for each program you have attended.
3.
Keep the original continuing education certificates of completion. Clock hours for continuing education are subject to audit by the Credentialing Board.
4.
Up to 10 of the 75 required clock hours can be obtained through submitted test questions for future CMAC exams. 2 Questions = 1 clock hour. For example, 20 questions = 10 clock hours. Identify which of the 5 Content Areas your question is related to.
Quality Assurance Audits The Center for Case Management will randomly audit 10% of the candidates applying for recertification by continuing education. If you are audited, you will be required to provide documented proof so keep your file up to date. All clock hours for continuing education must be obtained during the 5-year certification period. Professionally and ethically you are the best judge of which clock hours apply toward certification.
Contact Sources
* Professional Testing Corporation, 1350 Broadway, 17th Floor, New York, New York, 10018 USA (www.ptcny.com) ** CMAC, The Center for Case Management 386 Washington St – 2nd Flr, Wellesley, MA 02481 USA (www.cfcm.com )
COMPLETION OF APPLICATION PAGES 1 and 2 Use only a NUMBER 2 pencil to complete pages 1 and 2 of the Application. Please follow marking instructions to avoid delay in processing your Application. This Application will be scanned by computer, so please make your marks heavy and dark. Please print uppercase letters only, and avoid contact with the edge of the box. See the example provided on Application. CANDIDATE INFORMATION (Page 1): Starting at the top of page 1 of the Application, print the following information in boxes as directed in the Application. • Enter your name in the appropriate boxes. • Enter your mailing address and phone numbers in the rows of boxes provided. • Enter your current email address. • Enter date of Initial Certification • Enter date of Most Recent Certification (if applicable) • Enter Most Recent CMAC Certificate Number (required) ELIGIBILITY AND BACKGROUND INFORMATION (Page 1 and Page 2): In this section of the Application, a series of questions are asked to collect your background information. Fill in the circle next to the response you select to each question. NOTE: All questions must be answered. OPTIONAL INFORMATION (Page 2): The information requested relating to race, gender, and age is optional. It is requested to assist in complying with equal opportunity guidelines. It will be used only in statistical summaries and will in no way affect your recertification. CANDIDATE SIGNATURE (Page 2): Your signature consenting to the statement in the box. (Do not sign and date the Application until you have completed all information requested on Pages 1, 2, 3, and 4.) Applications without signature will not be accepted. PAGES 3 and 4 Following the directions on Pages 3 and 4, complete the documentation of Clock Hours. After you have completed all requested information, sign and date the authorizing statement on Page 4, then turn back to Page 2 and sign and date the Application in the space provided.
NOTE: Unsigned Applications will not be accepted. Mail the completed Application together with required documentation and the appropriate fee to: CMAC RECERTIFICATION 1350 Broadway, Suite 1705 NEW YORK, NY 10018 FEES Application fee for Recertification of Case Management Administrators: $375.00 Make check or money order payable to: Professional Testing Corporation. Credit cards are also accepted. Complete Credit Card Payment section on Page 2 of Application. *PLEASE SUBMIT YOUR COMPLETED APPLICATION AND FEE BY THE FOLLOWING DATE:
September 30 th for December 31st certification expiration.
***Recertification applications received after expiration dates will be denied*** Note: There will be no refunds of recertification application fees
Application for Recertification of Case Management Administrators Through Continuing Education Please read the directions in the Recertification Guideline carefully before completing this Application. MARKING INSTRUCTIONS: This form will be scanned by computer, so please make your marks heavy and dark, filling the circles completely. Please print uppercase letters and avoid contact with the edge of the box. See example provided.
Candidate Information Mr. First Name Mrs. Ms. Dr.
Middle Initial
Last Name
Suffix (Jr., Sr. , etc.) Apartment Number
Number and Street
City
State/Province
Daytime Phone
Zip/Postal Code
-
-
E-mail Address
Date of Most Recent Certification (if applicable) Most Recent CMAC Certificate Number (required)
Date of Initial Certification
/ Month
/ Year
RECORD TOTAL NUMBER OF CE HOURS FROM PAGE 4.
Month
Year
TOTAL CE HOURS:
Eligibility and Background Information Darken only one choice for each question unless otherwise directed.
C.
A. ELIGIBILITY ROUTE: (Darken only one response.)
Not applicable Less than 25% 25 to 50%
Master's Degree and 1 year in case management administration Master's Degree and 3 years as a case manager Bachelor's Degree and 3 years in case management administration Bachelor's Degree and 5 years as a case manager Currently certified as A-CCC, ACM, CRRN, CCM, or CDMS Faculty of a Case Management Program B.
CURRENT PRIMARY POSITION: (Darken only one response.) Case Management Administrator Case Manager Other (please specify) _____________________
PERCENT OF TIME CURRENTLY SPENT IN CASE MANAGEMENT ADMINISTRATION: 51 to 75% More than 75%
D. NUMBER OF CASE MANAGERS SUPERVISED: Not applicable 13 to 20 5 or less More than 20 6 to 12 E.
EXPERIENCE IN CASE MANAGEMENT ADMINISTRATION: Not applicable Less than 1 year 1 to 2 years
3 years 4 to 10 years More than 10 years
(Complete Page 2)
3778 CMAC-R, PROFESSIONAL TESTING CORPORATION, 1350 BROADWAY, 17th FLOOR, NEW YORK, NY 10018 WWW.PTCNY.COM (212) 356-0660 ALL RIGHTS RESERVED PTC10167
Application for Recertification of Case Management Administrators Through Continuing Education
Page 2
Eligibility and Background Information F.
J.
PERCENT OF TIME CURRENTLY SPENT IN CASE MANAGEMENT: Less than 25% 25 to 50%
PRIMARY PRACTICE SETTING: (Darken only one response.)
Academic Institution Acute Care Subacute Care Long Term Care Home Health Care
51 to 75% More than 75%
G. EXPERIENCE IN CASE MANAGEMENT: Less than 3 years 5 years 3 to 4 years More than 5 years
Hospice Integrated Network Managed Care Organization Third-party Payer Other (specify) __________
M. PLEASE LIST ALL CURRENT CERTIFICATIONS HELD:
H. HIGHEST ACADEMIC LEVEL ATTAINED: Bachelor's Degree Master's Degree I.
Doctoral Degree Other (specify) _________
PROFESSIONAL BACKGROUND: (Darken only one response.)
Nursing Social Work Medicine
Business/Hospital Administration Other (specify) ______________
Optional Information Note: Information related to race, age, and gender is optional and is requested only to assist in complying with general guidelines pertaining to equal opportunity. Such data will be used only in statistical summaries and in no way will affect your test results. Race: African American Asian Hispanic
Age Range: Under 25 25 to 29 30 to 39
Native American White No Response
Gender: 40 to 49 50 to 59 60+
Male Female
Candidate Signature COMPLETE ENTIRE APPLICATION BEFORE SIGNING BELOW. I have read the Guidelines for Recertification and understand that I am responsible for knowing its contents. I certify that the information given in this application is in accordance with Guidelines instructions and is accurate, correct, and complete.
CANDIDATE SIGNATURE: DATE:
CREDIT CARD PAYMENT
If you want to charge your application fee on your credit card provide all of the following information.
Name (as it appears on your card):
FOR OFFICE USE ONLY Date
0721
Address (as it appears on your statement): Charge my credit card for the total fee of: $ Card type:
Visa
MasterCard
Expiration date (month/year): Card Number:
American Express
/
Fee: CC
Check
Signature:
3778 CMAC-R, PROFESSIONAL TESTING CORPORATION, 1350 BROADWAY, 17th FLOOR, NEW YORK, NY 10018 WWW.PTCNY.COM (212) 356-0660 ALL RIGHTS RESERVED PTC10167
APPLICATION FOR RECERTIFICATION OF CASE MANAGEMENT ADMINISTRATORS THROUGH CONTINUING EDUCATION
PAGE 3
Directions:Use the form on Page 3 to list the programs you have attended, the relevant CONTENT AREA that applies to each program, and the clock hours. The Content Area must be identified for eachprogram you have included for clock hours. Provide a copy of the certificate of completion or other supporting documentation (such as transcripts for college course or course taught) for each program you have attended. Keep the original continuing education certificates of completion. Clock hours for continuing education are subject to audit by the Credentialing Board. Up to 10 of the 75 required clock hours can be obtained through submitted test questions for future CMAC exams. 2 Questions = 1 clock hour. For example, 20 questions – 10 clock hours. Identify which of the 5 Content Areas your question is related to. Note: Clock Hours for Continuing Education are subject to audit for the Credentialing Board of CMAC. Keep records for audit – Submit certificate of completion or other supporting documentation together with this Recertification Form.
Mo/Yr of Program
CONTENT AREA I. Identification Of At-Risk Populations II. Assessment Of Clinical System Components III. Development Of Strategies To Manage Populations IV. Leadership For Change V. Market Assessment And Strategic Planning VI. Human Resource Management VII. Program Evaluation Through Outcomes VIII. Measurement
Program Title
Clock Hours
List additional programs on separate sheet of paper, if needed, for 75 hours. Enclose with but do not staple to Application.
ENTER TOTAL NUMBER OF CLOCK HOURS OF CONTINUING EDUCATION PROGRAMS:____________
APPLICATION FOR RECERTIFICATION OF CASE MANAGEMENT ADMINISTRATORS THROUGH CONTINUING EDUCATION - CONTINUED
PAGE 4
Note: Clock Hours for Continuing Education are subject to audit for the Credentialing Board of CMAC. Up to 10 clock hours of continuing education for test questions can be submitted (2 Questions equal 1 clock hour). Questions need to be referenced and must have 4 possible answers. The stem should be stated positively. No true or false questions are permitted. No multiple choices stating all of the above or none of the above are permitted. Clock Hours (10 Maximum)
Test Questions (List on separate sheet of paper). (2 Questions equal 1 clock hour)
ENTER TOTAL NUMBER OF CLOCK HOURS OF TEST QUESTION:____________
D.
Before signing Candidate Affirmation, PRINT your name and number exactly as they appear on your current certificate ____________________________________________________________________ Name (PRINT)
E.
Number
****APPLICATION CHECK LIST****
CANDIDATE AFFIRMATION/AUTHORIZATION I certify that I have completed the requirements for the continuing education program(s) for which I am Submitting these Clock Hours for Continuing Education credits.
____________________________________________________________________ Signature
ENTER TOTAL CLOCK HOURS FROM PAGES 3 AND 4 HERE → AND ON THE BOXES INDICATED AT THE TOP RIGHT OF PAGE 2, ROUNDING TO THE NEAREST WHOLE NUMBER.
_____ Pages 1 and 2; completed and signed _____ Pages 3 and 4; completed and signed _____ Current Recertification by CE Fee enclosed. (See Guidelines for current fee)
Date
_________________________________________________________ Email Address
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