Care Coordination & Transition Management (65)

The CCTM online course and core text will help nurses solve the puzzle of fragmented patient care. It is an evidence-based, patient centered program designed to:

  • Improve patient outcomes
  • Enhance access to quality care
  • Decrease hospital readmissions
  • Decrease health care costs
  • Help patients navigate the health care system
  • Ensure continuity and seamless transitions among levels and settings of care
  • Work effectively in Patient-Centered Medical Homes (PCMHs)and Accountable Care Organizations (ACOs)
  • Improve the individual patient’s experience of care

The Course is also a useful resource to help you prepare for the Certified in Care Coordination and Transition Management (CCCTM) exam provided by the Medical-Surgical Nursing Certification Board (MSNCB) in collaboration with AAACN. Contact hours available until 3/31/2020.


The course includes an audio presentation, slides, and a PDF version of the corresponding core text chapter. Nurses will read the chapter prior to viewing the audio presentation. The course provides 26.4 contact hours.

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Additional sessions listed below fall into the category of care coordination and transition management, but are not part of our flagship course.

Care Coordination & Transition Management Products

Care Transition Hand-Off Toolkit

Care Transition Hand-Off Toolkit

May 11, 2018
Care Management Teams: An Amazon Prime Approach to Care Delivery

Care Management Teams: An Amazon Prime Approach to Care Delivery

May 11, 2018
RN-Led Medicare Wellness Visits – Nurses Providing Value in Meeting Your Organization’s Important Medicare Quality Metrics

RN-Led Medicare Wellness Visits – Nurses Providing Value in Meeting Your Organization’s Important Medicare Quality Metrics

May 11, 2018
Town Hall -  The Role of the RN in Non-Face-to-Face Nursing Practice: Meeting Health Needs and Improving Outcomes

Town Hall - The Role of the RN in Non-Face-to-Face Nursing Practice: Meeting Health Needs and Improving Outcomes

May 11, 2018
A Veteran’s Home Telehealth Experience: Chronic Care Management in the Comforts of Home

A Veteran’s Home Telehealth Experience: Chronic Care Management in the Comforts of Home

May 10, 2018
Advanced Illness Care: A Patient-Centered Approach to End-of-Life Care

Advanced Illness Care: A Patient-Centered Approach to End-of-Life Care

May 10, 2018
A Beat Above: How Implementing an RN-Managed Hypertension Clinic Changed Patient Care

A Beat Above: How Implementing an RN-Managed Hypertension Clinic Changed Patient Care

May 10, 2018