Managed Care Nurse
Managed care nurses act as liaisons between patients, healthcare providers, insurance companies and government organizations, working to ensure patients receive quality, cost-effective healthcare. Managed care nurses have specialized knowledge of the managed care system in which patients can only see designated medical professionals, such as Health Maintenance Organizations (HMOs), Preferred Provider Plans (PPOs) or government funded healthcare assistance programs like Medicare and Medicaid. Managed care nurses evaluate a patient's healthcare needs and connect them to cost-effective healthcare providers, counsel patients on the importance of preventative healthcare and work to keep costs down for patients and insurance companies.
In order to become a managed care nurse, students must first complete their Associate's Degree in Nursing or Bachelor of Science in Nursing degree and pass the NCLEX-RN exam. Managed care nurses generally begin their careers as staff nurses in clinics or private practices before moving into managed care. Others have a background in social work or social services before becoming an RN. RNs who want to specialize in managed care nursing may also seek the Certification in Managed Care Nursing credential administered by the American Board of Managed Care Nursing.
A typical job posting for a managed care nurse position would likely include the following qualifications, among others specific to the type of institution and patient population:
- ADN or BSN-level education and active RN license
- Certification in Managed Care Nursing credential a plus
- Experience working with managed care systems
- Strong interpersonal and communication skills for coordinating with patients, healthcare providers, insurance companies and government organizations on a daily basis
- Strong computer skills for inputting patient health assessments, updating records and completing required insurance documents
To search and apply for current managed care nurse positions, visit our job boards.
What Are the Education Requirements for Managed Care Nurse?
A position as a managed care nurse requires an ADN or BSN degree in addition to an active RN license. During the course of the nursing education, elective courses in social work are particularly helpful for a career in managed care nursing, as most managed care nurses work with patients who are using social services to pay for their healthcare. Generally, an advanced degree is not required, although some managed care nurses may choose to pursue a Master's of Science in Nursing degree if they wish to move into nursing management or leadership.
Are Any Certifications or Credentials Needed?
While not always a requirement for managed care nursing positions, earning the Certification in Managed Care Nursing credential administered by the American Board of Managed Care Nursing is certainly a competitive advantage for managed care nurses seeking employment.
Managed care nurses often work for health management organizations (HMOs), Preferred Provider Plans (PPOs) or government agencies and social services programs. They may also work in:
- Specialty clinics
- Community health centers
Managed care nurses use specialized knowledge of the managed healthcare system to connect patients to cost-effective healthcare providers who can deliver the quality of care they need. Managed care nurses educate patients about the importance of preventative healthcare, such as regular check-ups and vaccinations, healthy nutrition and exercise, which can decrease medical costs in the long term for both patients and insurance companies. Often working with the elderly and low income individuals who rely on government assistance like Medicare and Medicaid for their healthcare needs, managed care nurses act as a coordinator between patients, healthcare providers, hospitals and insurance companies to ensure patients have consistent access to quality medical care.
What Are the Roles and Duties of a Managed Care Nurse?
- Act as liaison between healthcare providers, nurse facilities, hospitals, patients and insurance companies to ensure consistent and cost-effective care
- Evaluate patient's plan of care and make recommendations about care alternatives that will aid in the quality of care for patients while keeping costs low
- Educate patients and caregivers about preventative healthcare, such as regular doctor's visits and vaccinations, as well as disease management
- Conduct physical, psychological and emotional assessments of patients to ensure they are receiving timely interventions and high quality care
Managed care nurse supervisors can expect a median salary of around $70,545, with a range of $64,000 – $88,322. Employment of registered nurses overall is projected to grow 16 percent from 2014 to 2024 according to the U.S. Bureau of Labor Statistics. The outlook for managed care nurses should also grow as the population ages and more individuals depend on managed care plans like Medicare.