Managed Care Nurse

The managed care nurse is a well-trained licensed nurse who is an advocate for both the health care insurer and the patient. Managed care nurses must hold a nursing license.

Managed Care Nurse Job Description & Scope of Practice

The managed care nurse is the liaison between the patients, the cost oriented health insurance provider, and the medical community. Patients with Medicare and Medicaid or managed care insurance, may see the managed care nurse who balances the need for cost-effective medical care with the patient’s needs. The managed care nurse’s focus is upon helping the patient stay healthy and avoiding unnecessary doctor visits and procedures.

However, the managed care nurse can advocate for specialists when the patient’s needs direct it. A managed care nurse might work in a large clinic, be placed in a hospital setting by their employer or represent patients in community health clinics.

The goal of this nurse is to obtain the best medical care possible for each patient while minimizing unnecessary visits. The managed care nurse usually emphasizes healthy lifestyle choices, encourages exercise and regular checkups.

In some office or clinic settings, the managed care nurse may also take on clerical or administrative duties. A few settings such as a managed care nurse placed in a small clinic may require the managed care nurse to perform certain bedside or office nurse functions.


How to Become a Managed Care Nurse

Most managed care nurses are RNs. Their education gives them a breadth of knowledge about patient care, anatomy, pharmacology and preventative care necessary for the job of a managed care nurse. An optional certification for managed care nurses is available and for the nurse new to the field it can give them an extra edge in the job market.

Most managed care nurses work a regular Monday through Friday schedule instead of shift work. A Bachelor degree in nursing can permit the graduate nurse to immediately pursue positions open for a managed care nurse.


Managed Care Nurse Education Requirements, Certification, and Schooling Programs

  • Managed care nurses must have graduated from an accredited nursing program. Although it is possible to become a managed care nurse with an LVN/LPN license the opportunities are rare and most managed care nurses are RNs.
  • Obtain voluntary certification in managed care. Although not required a voluntary certification which includes a program of learning can prepare the managed care nurse for the job market.
  • Certified Managed Care Nurses (CMCN) obtain credentials and certification through the American Board of Managed Care Nursing (ABMCN). Before taking the certification examination, applicants must complete a home study course given by the American Association of Managed Care Nurses (AAMCN). In addition to the home study, applicants must sit for the exam within 120 days of receiving the study materials. The exam consists of 150 multiple-choice questions covering vocabulary, concepts and applications of managed care. Certifications are renewed every three years and 25 hours of continuing education is required to recertify. Certification is not mandatory, but it is sought by employers.


Managed Care Nurse Salary and Career Outlook

The career prospects and job outlook for a managed care nurse are very good. The movement toward more cost efficient health care while keeping patient services intact is behind the increase in demand for managed care nurses.

The salary of these nurses depends upon their geographical location and their level of education. However, managed care nurses in general with an RN earn on average $73,000 a year. This salary is significantly above most staff nurse’s salaries. The prevalence of managed care nurses is predicted to increase as the number of elderly baby boomers on Medicare increase over the next few years.