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Old 06-03-2015, 12:32 PM
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Default Managed Care: A Growing Demand in Nursing

Managed Care: A Growing Demand in Nursing

Managed Care Defined

Managed care, or managed healthcare, refers to the approaches taken to optimize the delivery of healthcare benefits and increase the quality of care. Managed care principles are utilized by a wide variety of organizations such as Preferred Provider Organizations, Hospitals, Medicare and Medicaid programs, Nursing Homes, and Health Maintenance Organizations (HMOs). HMOs are organizations that provide health insurance or healthcare benefit plans. The catalyst for the managed care reform was the Health Maintenance Organization Act of 1973, which provided grants and loans for HMOs, overthrew state laws that restricted the development of HMOs, and required employers with 25 or more employees to offer two choices of federally qualified HMOs.

Duties of a Managed Care Nurse

Managed Care Nurses serve as the liaison between patients, doctors, healthcare providers and insurance companies. In contrast to direct patient care at the bedside, their role is to advocate for all patients enrolled in the healthcare delivery system. They often work with a diverse group of patients which may include the elderly and those who participate in government programs, such as Medicare and Medicaid. Managed care focus on the principles of patient education, wellness, prevention programs, early intervention, and continuity of care including transitional care and post-discharge education aimed at reducing readmissions. Other principles fall under several categories. Utilization and Quality Management keeps aspects like examination levels, technology and medication use efficient, while simultaneously improving patient outcomes. Disease Management, also known as Chronic Condition Management, is geared toward managing expenses and improving the quality of life for persons with long-term conditions. Care Management can involve developing and following through with comprehensive plans for individual care needs. The overall goal of a Managed Care Nurse is patient advocacy.

A model of Managed Care Nursing can include:

I. Collecting relevant information

II. Researching Educational Resources

III. Developing a Plan of Care

IV. Establish Patient Centered Goals

V. Implement Patient Centered Goals

VI. Evaluate Patient centered Goals

VII. Measuring Outcomes

How to become a Certified Managed Care Nurse

To become a Certified Managed Care Nurse (CMCN), you must hold a current registered nursing license or a license in practical nursing in any American State, territory, or protectorate. You must have proof of at least one year of full time employment as a Registered Nurse, Nurse Practitioner, Licensed Practical Nurse, or Licensed Vocational Nurse and pass an exam based on the components of Managed Care Overview, Healthcare Economics, Healthcare Management and Patient Issues.

The exam is administered by the American Board of Managed Care Nursing ( ABMCN has reading materials for reference posted, or candidates can visit the American Association of Managed Care Nurse’s website ( where they offer a preparatory Home Study Course that encompasses the required knowledge that must be obtained to pass the exam. Once the certification is acquired, nurses may use the initials “CMCN” (Certified Managed Care Nurse) as a part of their professional signature. This certification requires 25 continuing education credits every three years.

Career Outlooks

Nurses who specialize in specific areas of healthcare, such as managed care, are highly sought-after. The overall employment of registered nurses is expected to grow 19% from 2012 to 2022, faster than the average for other occupations. This growth is projected to occur for many reasons, such as the growing rate of chronic conditions and the aging Baby Boomer populations requiring more healthcare services. According to the Bureau of Labor Statistics, the average registered nurse makes a median of $65,000 per year. further defines a Managed Care Nurse’s yearly salary on the average at $70,000. However, Managed Care Nurses in management roles usually command larger salaries. A Managed Care Nurse Manager or Director in a metropolitan area like New York City can expect a salary upwards of $100,000 annually. Nurses who further their education with certification can undoubtedly gain career advancement through their enhanced knowledge.


Turner RN, MN, MBA, PhD, Susan Odegaard. The Nurse’s Guide to Managed Care. Gaithersburg: Aspen Publishers, Inc. 1999.

Kongstvedt, Peter. The Managed Care Handbook, 3rd ed. Gaithersburg: Aspen Publishers, Inc. 1996.

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Registered Nurses, on the Internet at (visited April 06, 2015).

Wikipedia, Managed Care. 18 March 2015. (visited April 06, 2015).

American Board of Managed Care Nursing. Candidates Guide for Certification in Managed Care Nursing. (visited April 06, 2015).

American Association of Managed Care Nurses. A Comprehensive Intro to Managed Care Nursing. Glen Allen: AAMCN. 2011. (visited April 06, 2015). National Salary Trend. “Managed Care Nurse”. (visited April 06, 2015).

Written by April L. Snyder. Edited by Jacquelyn Smith, RN, BSN, MA, CMCN, President of the American Association of Managed Care Nurses (AAMCN). Copyright © 2015.
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