CMSNE 2023 Award of Service Excellence Application

This award recognizes an “in-the-trenches,” grass roots case manager whose day-to-day case management practice has transformed their field and contributed to the greater good — not only for their clients but for their community as well. CMSNE desires to recognize the extraordinary importance one individual can make through initiative, inspiration of others, and significant contributions to improving the quality of CM practice.

Please consider nominating a colleague or yourself for a CMSNE Award of Service Excellence Recognition
- Nominees are Case Managers from all disciplines who go above and beyond for their clients, exemplifying outstanding commitment and achievement in the practice of case management.
- The nominee must meet the minimum criteria outlined below, as well as any additional evidence of excellence in the case management practice.

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* 1. Award of Service Excellence Nominee

Name

Credentials

Title

Email Address

Phone Number

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* 2. In an effort to gather more information about this nominee, the CMSNE CMOY/AOSE Committee would like to reach out and schedule a brief Zoom interview with this case manager. The goal would be just to get to know the nominee and learn more about their Case Management passion and practice.

Does the individual know that you have nominated them for this award? Select if yes.

If the individual does not know that you have nominated them for this award, are you comfortable with CMSNE connecting with them? Select if yes.

Would you be willing to participate in a 10-15 minute Zoom meeting with your nominee and committee members to learn more about the candidate? Select if yes.

Comments

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* 3. Minimum Criteria

Two years as active CMSNE member, current member status at time of nomination

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* 4. Professional Experience Documentation

If available please upload nominees resume, CV or biographical statement.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 5. Nominee must have at least one national healthcare-related certification at the time of nomination - To the best of your knowledge please provide the following information.

CCM

CDMS

CRC

CRRN

COHN/CM

CMAC

C-SWCM

CMCN

CMGT-BC

QPCM

ACM

Other (please specify. i.e. OT, PT, RT certifications)

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* 6. Excluding yourself, please submit: at least 2 letters of recommendation and/or commendation, describing why your nominee is deserving of the recognition of Award of Service Excellence. One letter must be from nominee’s current employer where nominee has been actively case managing cases for at least one year of employment. One should include a complete explanation as to why this case manager is submitted for the Award of Service Excellence. (Refer to Criteria Sheet attached when creating recommendations.)

Reference 1 Employer

Name

Relationship

Phone

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* 7. Reference 2

Name

Relationship

Phone

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* 8. Please contact your nominee references to request a written reference. The reference should be submitted to the CMSNE chapter office at CMSNE@comcast.net no later than August 31, 2023. Written recommendations should include reference to the nominees criteria for meeting this distinction. Criteria can be found by downloading this file: https://www.cmsne.org/wp-content/uploads/2023/02/2023-CRITERIA-FOR-RECOGNITION-OF-SERVICE-EXCELLENCE-AWARD.pdf

I have reached out to the individuals identified to provide a recommendation and have shared criteria and deadline for submitting.

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* 9. Upload your personal Nominee recommendation and/or commendation here.

If your recommendation is not available at this time, please send to the chapter office at cmsne@comcast.net no later than August 31, 2023. Make a notation in email message "CMSNE AOSE Recommendation".

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Please complete the areas below that are applicable to your nominee: (Upload additional document if/as necessary.)

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* 10. Case Management Program(s):
Describe program, training, and outcomes for any nominee provided or assisted in product direction or development for case management programs within the last two years.

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* 11. Participated in various task force, committee, or advisory panels advancing integrated care management strategies. Please describe the focus patient population and the outcomes. (Space allotted for 2 entries, if additional space is required, please upload a separate document below)

#1 Position Title

Organization

Focus of work

Contribution

Other Information

Comments

#2 Position Title (if needed)

Organization

Focus of work

Contribution

Other

Comments

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* 12. Service Excellence:
What actions does the nominee demonstrate that shows service excellence in the case management community on a daily frontline basis?

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* 13. Case Management Innovation:
Describe the nominee’s innovations, creativity, and resourcefulness incorporated in their case management practice, and the resulting benefits.

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* 14. Community Service:
Describe the nominee’s community service offered outside of job requirements where they served others in the community by utilizing their case management skills in a non-practice setting.

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* 15. Please feel free to add any additional documentation that you feel would enhance this individual's nomination.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 16. To the best of my knowledge, the information submitted with the Nomination is true and accurate.

Name

Relationship

Email Address

Phone Number

CMSNE 2023 Award of Service Excellence Application

Question Title

* 1. Award of Service Excellence Nominee

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* 2. In an effort to gather more information about this nominee, the CMSNE CMOY/AOSE Committee would like to reach out and schedule a brief Zoom interview with this case manager. The goal would be just to get to know the nominee and learn more about their Case Management passion and practice.

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* 3. Minimum Criteria

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* 4. Professional Experience Documentation

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* 5. Nominee must have at least one national healthcare-related certification at the time of nomination - To the best of your knowledge please provide the following information.

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* 7. Reference 2

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* 9. Upload your personal Nominee recommendation and/or commendation here.

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* 10. Case Management Program(s): Describe program, training, and outcomes for any nominee provided or assisted in product direction or development for case management programs within the last two years.

Question Title

* 11. Participated in various task force, committee, or advisory panels advancing integrated care management strategies. Please describe the focus patient population and the outcomes. (Space allotted for 2 entries, if additional space is required, please upload a separate document below)

Question Title

* 12. Service Excellence:What actions does the nominee demonstrate that shows service excellence in the case management community on a daily frontline basis?

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* 13. Case Management Innovation:Describe the nominee’s innovations, creativity, and resourcefulness incorporated in their case management practice, and the resulting benefits.

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* 14. Community Service:Describe the nominee’s community service offered outside of job requirements where they served others in the community by utilizing their case management skills in a non-practice setting.

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* 15. Please feel free to add any additional documentation that you feel would enhance this individual's nomination.

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* 16. To the best of my knowledge, the information submitted with the Nomination is true and accurate.

* 10. Case Management Program(s):
Describe program, training, and outcomes for any nominee provided or assisted in product direction or development for case management programs within the last two years.

* 12. Service Excellence:
What actions does the nominee demonstrate that shows service excellence in the case management community on a daily frontline basis?

* 13. Case Management Innovation:
Describe the nominee’s innovations, creativity, and resourcefulness incorporated in their case management practice, and the resulting benefits.

* 14. Community Service:
Describe the nominee’s community service offered outside of job requirements where they served others in the community by utilizing their case management skills in a non-practice setting.