Certificate Program in Integrated Care Management

This database is no longer actively maintained and is here for archival purposes only

Organization Type: 
Educational Institution
Program Type: 
Standing Program
Education Level: 
Postgraduate (e.g., residency, fellowship)
Continuing Education
Technical certificate programs or certificate training programs
Educational Elements: 
Program Description: 

This Certificate Program trains health professionals to function successfully as PCMH care managers who work directly with both patients and members of the care team.  Through this program, care managers learn to address behavioral health issues, coordinate care, and help manage chronic illnesses and the health behaviors of their patients.  For example, care managers will learn general skills for engaging patients, promoting patient activation to improve their own health, and general medical and behavioral health skills to be able to connect patients to appropriate services, address questions, and educate them on healthy living and support treatment plans.

The Integrated Care training program consists of ten sessions, each with two modules, totaling twenty hours over the course of the program including:

  • Care Management in the PCMH
  • Improving Patient Experience
  • Fostering Patient Activation
  • Fostering Shared Decision Making
  • Team Approaches to Care
  • Evidence Based Protocols, Depression Care Management
  • Resources and Working in the “Healthcare Neighborhood”
  • Successfully Caring for Homeless Patients
  • Successfully Caring for Patients with Serious and Persistent Mental Illness
  • Care Managing for Geriatric Populations
  • Working with Unhealthy Substance Use
  • Understanding and Helping People with Chronic Pain
  • Trauma Informed Care
  • Crisis Intervention
  • Diabetes + Heart Disease 101
  • Controlling Weight and Supporting Exercise for Healthy Living
  • Smoking Cessation
  • Group Programs for Healthy Behavior
  • Motivational Interviewing
  • Culturally Competent Care
Targeted Professions
Registered Nurses
Licensed Practical Nurses
Social Work: 
Psychiatric social work
Medical social work
Clinical Health
Medical Assistants
Patient Educators
Physician Assistants
Self-Reported Competencies
PCPCC’s Education and Training Task Force identified 16 interprofessional training competencies critical for preparing health professionals for practicing in team-based, coordinated care models such as patient-centered medical homes. Listed below are the self-reported competencies that this program has achieved, which have been organized by the five core features of a medical home as defined by the Agency for Healthcare Research and Quality
Patient-Centered Care Competencies: 
Advocacy for patient-centered integrated care
Cultural sensitivity and competence in culturally appropriate practice
Development of effective, caring relationships with patients
Patient-centered care planning, including collaborative decision-making and patient self-management
Comprehensive Care Competencies: 
Assessment of biopsychosocial needs across the lifespan
Population-based approaches to health care delivery
Risk identification
Coordinated Care Competencies: 
Care coordination for comprehensive care of patient & family in the community
Health information technology, including e-communications with patients & other providers
Interprofessionalism & interdisciplinary team collaboration
Team leadership
Quality Care & Safety Competencies: 
Assessment of patient outcomes
Evidence-based practice
Quality improvement methods, including assessment of patient-experience for use in practice-based improvement efforts
Accessible Care Competencies: 
Promotion of appropriate access to care (e.g., group appointments, open scheduling)
Last updated November 15, 2013

* Please note: Information contained in this database is self-reported by representatives from each program. It does not represent an exhaustive list of education and training programs and inclusion does not constitute an endorsement from the PCPCC.


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