American Association of Managed Care Nurses

“Educating Nurses in Case, Utilization and Quality Management”
   

 

 

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Current Issue of Nurses’ Notes

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Welcome to the AAMCN!

Managed care nurses are a valued resource utilized by many organizations such as health care institutions, health plans, IRO/EQRO or accreditation organizations and health care providers/vendors to ensure improved coordination and positive outcomes of clients’ care. They ensure that desired clinical outcomes can be achieved in a cost-effective manner that ultimately supports the client, the organization, and ultimately the delivery of health care.

 
The managed care nurse practices in a variety of  settings and may work directly with their clients/caregivers and providers, acting as a liaison be­tween the professional and facility providers, the managed care organization (MCO), and community agencies.  They may also practice in settings delivering  direct member care, particularly those organization assuming financial or clinical outcome risk such as in population management health programs or in compliance  or accreditation organizations.

 

The functions of the managed care nurse include, but are not limited to, the following:   

·         Clinical program development, implementation and management

·         Regulatory compliance

·         Provider and vendor management

·         Data gathering and analysis

·         Development of an integrated plan of care

·         Coordination of care and services through the continuum

·         Establishment, implementation and evaluation of client-centered goals

·         Outcomes measurement and analysis

·         Education of managed care consumers on all aspects of their healthcare   

·         Researching and identifying community resources

·         Advocate for the consumer

 

 

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2014 Spring Managed Care Forum
April 24-25, 2014
Orlando, Florida


 


 

We’d like to thank our Corporate Partners for their continuous support!

 
     

 

Congratulations to the 2013 Managed Care Nurse Leader of the Year!
Sponsored by Morgan Consulting 

Sheryl Riley RN, OCN, CMCN!