Managed care nurses are nursing professionals with specialized knowledge of managed care systems, as well as the patients and medical professions that rely upon them. These nurses essentially act as liaisons between patients, healthcare providers, insurance companies, and government organizations, working to make sure patients received effective, low-cost healthcare. Nurses in this specialty field have specialized knowledge of the managed care systems that patients use, like Health Maintenance Organizations (HMOs), Preferred Provider Plans (PPOs), or government-funded healthcare assistance programs like Medicaid. In order to keep costs down, managed care nurses often focus on preventative care methods, working alongside doctors and healthcare facilities to implement those methods. Managed care nurses work with a wide variety of patients who may need different types of medical care. Often, they will find themselves working with low-income and underserved individuals, or families who rely on government-funded healthcare programs.
Duties commonly carried out by managed care nurses include the following:
While managed care nurses can be found in a variety of settings, the most common workplace environments include:
Typically, before making the transition into managed care nursing, individuals will gain several years of clinical experience as a traditional RN, working in public or private settings. Some managed care nurses will have backgrounds in social work or social services before choosing to go into nursing. A strong understanding of medical insurance organizations, processes, benefits, and resources is a must for this job role.
After gaining a number of years of clinical experience, nurses can seek out a Certification in Managed Care Nursing credential through the American Board of Managed Care Nursing.
The following educational requirements should be fulfilled prior to applying for managed care nurse positions:
Note: Although a graduate degree isn't required, managed care nurses who wish to move into leadership or nursing management roles should pursue a Master's of Science in Nursing. During one's undergraduate nursing education, it's strongly suggested to take elective courses in social work.
Yes, managed care nurses must have an active and unrestricted RN license in order to practice in their specialty.
The organizational bodies that award Certifications in Managed Care Nursing are the American Board of Managed Care Nursing (ABMCN) and the American Association of Managed Care Nurses (AAMCN).
In order to be eligible for the AAMCN's certification exam, you'll need the following:
While not always a requirement for managed care nursing positions, earning the Certification in Managed Care Nursing credential is certainly a competitive advantage for managed care nurses seeking employment.
The millennial generation is set to become the country's largest in the coming years. Unfortunately, many struggle to afford healthcare and must use government programs like Medicaid to have access to medical professionals. Because of this, managed care nurses will be needed - perhaps more than ever - in the coming years.
According to PayScale, the average salary of a certified managed care nurse is around $74,000 per year. However, how much a managed care nurse is paid will vary significantly and depend on factors such as employer, the city and state of employment, education level, credentials held, and experience level. The contents of employee benefit packages will also be influenced heavily by the same factors. Nonetheless, since managed care nurses are often employed by the government, many can expect to receive health insurance and a bit of annual paid time off and sick leave.