Recognize Service Excellence
Please consider nominating a colleague or yourself
for a CMSNE Recognition of Excellence Award
CMSNE AWARD OF SERVICE EXCELLENCE (AOSE)
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.
The evaluation process for this annual recognition utilizes Letters of Recommendation to determine the nominee’s contribution to:
 Advancing case management
 Exemplifying the Standards of Care and Standards of Performance as defined in CMSA’s Standards of Practice for Case
Management
 Demonstrating service excellence to clients and the case management community on a daily frontline basis
 Incorporating innovation, creativity and resourcefulness in his/her case management practice
 Serving others through community service by utilizing their case management skills in a non-practice setting.
Name of Nominee:
Address:
City:
State:
Zip Code:
Employer: ___________________________________________ Title:_______________________________________________________
Phone: _____________________________ h w c Email: _______________________________________________________________
List academic credentials/degrees: ____________________________________________________________________________________
National certification at time of nomination: CCM _____ CDMS _____ CRC _____ CRRN _____ COHN _____ Other
CMSA/CMSNE member number or date of initial membership:
I.
Minimum Criteria
 Two years as active CMSNE member, current member status at time of nomination
 Must have at least one national healthcare-related certification at time of nomination. (CCM, CDMS, CRC, CRRN, COHN, etc.).
 Current* Curriculum Vitae or other form of documentation must indicate that the nominee is actively managing cases at the time of
receiving the award.
II. Excellence in Case Management Practice
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.)
Please provide contact information for the written references included with this application:
Name: ___________________________
Relationship: _____________________
Phone: __________________________
Email: ___________________________
Name: ___________________________
Relationship: _____________________
Phone: __________________________
Email: ___________________________
Name: ___________________________
Relationship: _____________________
Phone: __________________________
Email: ___________________________
Please complete the areas below that are applicable to your nominee: (Use additional space if/as necessary.)
Case Management Program(s):
Describe program, training, and outcomes for any nominee provided or assisted in product direction or development for case
management programs with current or previous employers within the last two years.
Program Title:
Description:
Location:
Outcomes:
Other:
Contributions to Patient Centered Solutions:
Share how this Nominee exemplifies the role of case manager by participating in various task force, committee, or advisory panels advancing
integrated care management strategies.
List task force, committee, or advisory panels with focus of work and personal/professional contributions toward innovative patient centered
solutions to demonstrate quality and cost efficient outcomes.
1) Position Title:
Organization: Select
Focus of work:
Contribution:
Other Information:
2) Position Title:
Organization: Select
Focus of work:
Contribution:
Other Information:
Patient Population Programs/Outcomes:
What programs/outcomes demonstrate/illustrate the implementation of assessment, planning, facilitation and advocacy with patients and
patient population? Describe patient and/or patient population programs and outcomes:
Service Excellence:
What actions demonstrate service excellence to clients and the case management community on a daily frontline basis? Describe patient
and/or patient population programs and outcomes:
Case Management Innovation:
Describe innovations, creativity, and resourcefulness incorporated in their case management practice, and the resulting benefits.
Describe Innovations:
Describe Benefits:
Community Service:
Describe 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.
Describe Community Service:
Other: (Share additional information about why you are nominating this individual for CMSNE’s ASOE that do not match the above
topics.)
To the best of my knowledge, the information submitted with the Nomination is true and accurate.
Signature:
Your Name Printed:
Title:
Relation to Nominee:
Phone: _______________________________________________ Email: ____________________________________________________
Nominators are encouraged to also include a letter summarizing why you feel this nominee is deserving of the AOSE award.
Nomination Form and Supportive Documentation must be
POSTMARKED BY AUGUST 31, 2016
Case Management Society of New England, 2 Nashua Rd., Pelham, NH 03076 – 603-329-7481
CRITERIA FOR RECOGNITION OF SERVICE EXCELLENCE AWARD
Minimum Criteria:
 Must be current member of CMSNE for two years and currently in good standing.
 Must have at least one national healthcare-related certification at time of nomination. (CCM, CDMS, CRC, CRRN, COHN,
etc.).
 Current Curriculum Vitae or other form of documentation must indicate that the nominee is actively managing cases at the
time of receiving the award.
 Two (2) letters of reference who can provide additional information to support the nominee for this award.
Award Criteria:
 Nominee should have made significant contributions to their current and previous employers, and have demonstrated
innovative service to their clients and the practice of case management.
 Nominee should be recognized as a “thought leader” committed to CMSA’s mission … advancing case management.
 Two Letters of Recommendation. • 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.
 Recommendation must include how the nominee’s contributions:
• Advance case management
• Exemplify the “Standards of Care and Standards of Performance” as defined in CMSA’s Standards of Practice for
Case Management †
• Demonstrate service excellence to clients and the case management community on a daily frontline basis
• Incorporate innovation, creativity and resourcefulness in their practice
• Serving others through community service by utilizing their CM skills in a non-practice setting
† Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for
options and services to meet an individual’s and family’s health needs through communication and available resources to promote
quality cost-effective outcomes. Standards of Practice for Case Management — Revised 2010©
What happens to your entry?
 Entries are screened for minimum criteria at local office
 Entries meeting minimum criteria are forwarded to CMOY/Scholarship Committee
 Each entry is individually evaluated according to official criteria as outlined above
 The Committee evaluates entries. The highest ranking entry will be recommended by the Committee to receive the
Distinguished Award of Service Excellence. In the event of a tie it is the discretion of the Committee to make the final choice
as to the recipient of the award.
 The Board ratifies the recommendation and the Committee Chair and CMSNE President notifies the recipient.
 The Recognition of Excellence Awards will be presented at the CMSNE Annual Conference in October 2016.
Award Benefits
 Complimentary Full-Conference Attendance for Winner
 Official Award Ceremony Recognition at Annual Conference
 Recognition Plaque
 Announcement in Chapter Newsletter and website
 One Year Complimentary CMSNE Chapter Membership
Further inquiries on Recognition of Excellence Awards can be directed to:
CMSNE, 603-329-7481, Email: CMSNE@comcast.net