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e in Medicare and medicaid programs in 1994. Case management provided by nursing initiatives became an effective way to meet these goals.

The emergence of managed care and HMOs created a need for case managers in inpatient and outpatient/primary care (Zander, 2002, 59). The development of disease management programs by pharmaceutical companies, and then by payers and providers also created a need for nurse case managers. This new need led to the development of the Case Management Administrator Certification program, which tests seven core components which are tested for competency:

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