Managed care is a type of health care system in which patients are only able to see certain designated medical professional. Some examples of managed care health insurance plans include Health Maintenance Organizations (HMO’s) and Preferred Provider Plans (PPO’s) as well as government funded healthcare assistance programs. These managed care plans focus on preventive health care in an effort to keep costs down, and often offer incentives to physicians and healthcare facilities that participate in these plans.

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What is a Managed Care Nurse?
What do Managed Care Nurses Do?
Where do Managed Care Nurses Work?
How do I Become a Managed Care Nurse?

What is a Managed Care Nurse?

A managed care nurse is a nursing professional that has a specialized knowledge of managed care systems, and the medical professionals and patients that rely on them. Managed care nurses play an integral role in ensuring that these systems run smoothly.

As a managed care nurse, you will work directly with patients, physicians, nurses, medical facilities, insurance companies, and government agencies. You will frequently act as a liaison and educator, ensuring that patients receive high quality health care when they need it. However, you will also be responsible for trying to keep healthcare costs down.

You will work with patients of all types, including the young and old, who may need all different types of medical care. Oftentimes, you may find yourself working with low-income individuals and families that rely on government funded healthcare programs, such as Medicare and Medicaid.

A managed care nursing career has a number of advantages over some other nursing careers. For instance, you will often work regular hours and a somewhat chaos-free work environment. However, you will also spend more time completing paperwork rather than directly caring for patients.

What do Managed Care Nurses Do?

One of the main responsibilities of a managed care nurse is to keep the cost of health care down for both patients and insurance companies. In order to do this, these nursing professionals focus on making sure that patients aren’t undergoing unnecessary medical procedures and encouraging patients to seek preventive medical care.

Unnecessary medical procedures can drive the cost of health care through the roof. Managed care nurses work with doctors and patients to make sure that patients are not undergoing expensive medical procedures that they don’t need. This may involve interviewing physicians and examining patient medical records.

In the long run, preventive medical procedures cost much less than major medical procedures that patients may need when they get ill. Therefore, managed care nurses will often work to ensure patients are seeking the proper preventive procedures they need. These procedures may include regular checkups, health screenings, vaccinations, and immunizations. Managed care nurses often counsel and educate patients on the importance of these procedures, which not only keep overall medical costs down, but also helps prevent major illnesses or catch them early.

Ensuring quality care for patients in a managed care setting is another important aspect of being a managed care nurse. These nursing professionals work to ensure each patient gets the care he or she needs and may even work to find ways to improve the overall quality of care in a medical facility.

Where do Managed Care Nurses Work?

Generally, managed care nurses work in office settings rather than in clinical settings. They are often employed by clinics, hospitals, community health centers, and insurance companies. Some government agencies and social service programs may also hire managed care nurses.

How do I Become a Managed Care Nurse?

To become a managed care nurse, you will first need to become a registered nurse. In order to do this, you will need to earn your nursing diploma or degree and pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Once you’re licensed, you can then start gaining experience in a clinical setting.

Below is the educational path for an Managed Care Nurse (lowest to highest level of education)

Educational TrackSchool ProgramsAverage Education LengthChoosing Online or Campus
Earn a Bachelors DegreeView Programs4 Years Online or Campus
Earn a MSN DegreeView Programs2 Additional YearsOnline or Campus
Earn a PHD or DNPView Programs2-4 Additional YearsOnline or Campus

The American Association of Managed Care Nurses (AAMCN) offers certification for managed care nurses. To be able to sit for the certification examination, you must have a valid license as a registered nurse and three to five years of experience in a clinical setting. You must then complete a home study program in managed care nursing that covers four important areas, including an overview of managed care, healthcare economics, healthcare management, and patient issues.

You may be able to skip the home study program if you can provide evidence of experience or education that is equivalent to the program course work.