Sample Simulation Case

What the learner does

1. 1

   1. Review the chart

   72M with pneumonia, Medicare Advantage, inpatient ordered. Learner reviews vitals, labs, imaging, comorbidities, and documentation snippets—no PHI required.

2. 2

   2. Select key facts

   From a mixed list of 16 items, the learner picks the facts that matter most for status support (O2 needs, tachypnea, IV antibiotics, comorbidity risk) and avoids noise (e.g., lives with spouse).

3. 3

   3. Call out documentation gaps

   They describe what is missing in the 'why inpatient today' narrative and what they would ask the provider to clarify.

4. 4

   4. Choose a next step

   They choose up to two actions—such as request documentation and initiate status review/escalation—and set a timeframe (today, tomorrow, next review).

5. 5

   5. Roleplay a payer-style call

   An MA concurrent review nurse challenges whether inpatient is needed today. The learner explains their rationale using only case facts and states their plan if documentation stays weak.

6. 6

   6. Document the plan

   They complete a short, structured note: status support summary, documentation requested, escalation, payer contact, and follow-up timeframe.

What the manager sees

• Overall score and readiness label (Ready / Developing / Not ready).
• Subscores for fact triage, documentation gaps, decision quality, roleplay, documentation note, and independence.
• Top strengths, misses, and recommended coaching actions.
• Evidence sections: selected facts, gaps response, decision choices, roleplay summary, and note output.