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.
What Are Some Managed Care Nurse Duties?
Duties commonly carried out by managed care nurses include the following:
Closely assess a patient's emotional, physical, and psychological state in order to ensure they receive timely interventions and quality care
Act as a link between patients, healthcare providers, insurance companies, and doctors to ensure effective low-cost healthcare
Teach patients, along with their loved ones or caregivers, about preventive care measures
Encourage regular doctor visits and staying up to date on vaccinations to help patients maintain their health and to reduce medical costs
Assess the care plans of patients and make recommendations to ensure efficacy and cost-effectiveness
Where Do Managed Care Nurses Work?
While managed care nurses can be found in a variety of settings, the most common workplace environments include:
Hospitals
Medicaid & Medicare
Government health clinics
Community health clinics
Telephone triage centers
Health insurance companies
How to Become a Managed Care Nurse
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.
Step 1: Educational Requirements
The following educational requirements should be fulfilled prior to applying for managed care nurse positions:
Hold an Associate's Degree in Nursing (ADN) from an accredited college or university
OR
Hold a Bachelor's of Science in Nursing (BSN) from an accredited college or university
Have passed the National Council Licensure Examination (NCLEX-RN)
Possess an active and unrestricted RN license
Several years of experience working as a traditional RN
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.
Do Managed Care Nurses Need an RN Degree?
Yes, managed care nurses must have an active and unrestricted RN license in order to practice in their specialty.
Step 2: Required Managed Care Nurse Certifications/Credentials
In order to be eligible for the AAMCN's certification exam, you'll need the following:
A valid and unrestricted RN license
3-5 years of experience in a clinical setting
Complete a home study program in manage care nursing which covers the following areas:
Managed care
Healthcare management
Healthcare economics
Patient issues
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.
Managed Care Nurse Jobs, Salary & 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.
Job Description & Information
Essential Skills Needed - Strong assessment skills, well-honed computer skills, extensive knowledge of various kinds of managed care nursing software, strong communication and interpersonal skills, ability to work well alone or in teams
Job Outlook - The U.S. Bureau of Labor Statistics projects that jobs in the nursing sector will grow by 16% through 2024. This growth rate is substantially higher than most other fields of work. Managed care nurses can expect their specialty field to grow at a similar rate to that of the traditional nursing sector.
What Is the Average Salary of a Managed Care Nurse?
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.
