CMSNE 2022 Case Manager of the Year Nominee Application

CMSNE 2022 Case Manager of the Year Application

Please consider nominating a colleague or yourself for a CMSNE CMOY Recognition of Excellence Award
- 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. Case Manager 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 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

Five years of current work experience in case management

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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. Bonus Criteria - Certification - 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. Bonus Criteria - Participation in CMSNE - To the best of your knowledge please provide the following information.

Member of Board of Directors (elected officer)

Committee Chair/Member

Presented educational session, webinar or poster

Other (please specify)

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* 7. Bonus Criteria - Participation in CMSA at a national level - To the best of your knowledge please provide the following information.

Member of National Board of Directors (elected officer)

National Committee Chair/Member

National Task Force Chair/Task Force Member

Presented national educational session, webinar or poster

Authored an article published in CMSA Today

Other (please specify)

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* 8. Bonus Criteria - Participation in other professional organizations - To the best of your knowledge please provide any additional information.

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* 9. Excluding yourself, please share two additional references who can endorse this case manager's nomination for CMSNE Case Manager of the Year (CMOY)

Reference 1

Name

Relationship

Phone

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* 10. Reference 2

Name

Relationship

Phone

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* 11. 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, 2022. 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/2022/03/2022-criteria-sheet.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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* 12. 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, 2022. Make a notation in email message "CMSNE CMOY Recommendation".

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

Choose File

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* 13. Please feel free to share any additional information that you feel would enhance this individual's nomination.

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

Name

Relationship

Email Address

Phone Number

CMSNE 2022 Case Manager of the Year Nominee Application

CMSNE 2022 Case Manager of the Year Application

Question Title

* 1. Case Manager Nominee

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* 2. In an effort to gather more information about this nominee, the CMSNE CMOY 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.

Question Title

* 3. Minimum Criteria

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* 4. Professional Experience Documentation

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* 5. Bonus Criteria - Certification - To the best of your knowledge please provide the following information.

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* 6. Bonus Criteria - Participation in CMSNE - To the best of your knowledge please provide the following information.

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* 7. Bonus Criteria - Participation in CMSA at a national level - To the best of your knowledge please provide the following information.

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* 8. Bonus Criteria - Participation in other professional organizations - To the best of your knowledge please provide any additional information.

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* 9. Excluding yourself, please share two additional references who can endorse this case manager's nomination for CMSNE Case Manager of the Year (CMOY)Reference 1

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* 10. Reference 2

Question Title

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

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* 13. Please feel free to share any additional information that you feel would enhance this individual's nomination.

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

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

* 9. Excluding yourself, please share two additional references who can endorse this case manager's nomination for CMSNE Case Manager of the Year (CMOY)

Reference 1