Become a Certified Managed Care Nurse (CMCN)

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.

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 focuses 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.

Duties of a Managed
Care Nurse

CMCN Process

To become a Certified Managed Care Nurse (CMCN), or Certified Managed Care Professional (CMCP for licensed social workers), you must hold a current registered nursing license or a license in practical nursing in any American State, territory, protectorate, or a valid social worker license.  You must 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.org). ABMCN has reading materials for reference posted, or candidates can visit the Home Study Page where they offer information on the 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) and licensed social workers may use “CMCP” (Certified Managed Care Professional) as a part of their professional signature. This certification requires 25 continuing education credits every three years.

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. Indeed.com 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.

Career Outlooks