Career Path Guide
If you want to become a managed care nurse, you first need to determine if this career path is a good fit for your skills, interests and personality traits.
If the following description sounds like you, then you’re probably well suited for it:
• You have a good understanding of health care economics
• You are interested in helping keep health care costs down for those without strong insurance plans
• You have an interest in working in a patient-facing nursing capacity
• You are able to balance quality care with cost effectiveness
• You are able to develop, implement and manage clinical programs
• You would enjoy acting as a liaison between different groups, such as doctors, patients, health care providers, etc.
Below we've outlined what you'll need to begin a career as a managed care nurse. We've also included helpful occupational information, such as job description, job duties, salary expectations, a list of possible employers and much more!
Education Needed to Become a Managed Care Nurse
Nursing is a regulated profession in both Canada and the United States. The educational requirements for becoming licensed as a nurse depend primarily on whether the nurse wants to become a Registered Nurse (RN) or a Licensed Practical Nurse (LPN).
Education Needed to Become a Registered Nurse (RN)
Canada: In Canada, you must first earn a Bachelor of Nursing degree before you can qualify for becoming a Registered Nurse.
United States: In the United States, you can qualify for becoming a Registered Nurse by earning a Nursing Diploma, an Associate of Science in Nursing (ASN) or a Bachelor of Science in Nursing (BSN).
Education Needed to Become a Licensed Practical Nurse (LPN)
Canada: To become a Licensed Practical Nurse in Canada (or Registered Practical Nurse - RPN in Ontario), you must be a graduate of an approved practical nursing education program, which is typically 2 years in duration, and includes a combination of classroom and laboratory instruction, and clinical experience in various health care settings.
United States: To become a Licensed Practical Nurse in the United States, you must complete an LPN training program, which may be offered at a technical school, vocational school or community college. These programs are typically 12 months in duration.
General Job Description
Managed Care Nurses work with patients who primarily rely on government-funded healthcare within largely privatized healthcare systems. They often work with those who rely on programs like Medicare or Medicaid.
They work to keep the patient’s medical costs down by helping patients practice preventative care, and encouraging regular check-ups and vaccinations for themselves and their families. Managed care nurses are ultimately responsible for ensuring that desired clinical outcomes can be achieved in a cost-effective manner that supports the client, the organization, and ultimately the delivery of health care to the patient.
Managed care nurses often work directly with patients and their caregivers, and act as a liaison between the patient, the doctor, facility staff, the patient's insurance company, the managed care organization and relevant community agencies.
Typical Job Duties
• Communicate with patients and their family, with a focus on relieving anxiety
• Maintain comprehensive patient records
• Make ethical decisions related to confidentiality and consent
• Act as a patient advocate
• Teach patients how to practice preventative care
• Work with diverse group of patients
• Organize staff and delegate work duties
• Perform setup for blood transfusions
• Write patient care plans
• Measure and analyze outcomes of care plan
• Administer medication and injections
• Observe and record the condition of the patient
• Respond to emergencies as necessary
Skills Needed to Be Successful
To be effective in a career as a managed care nurse, and perform your job duties with competence, you need to posses a certain set of skills, including:
• Able to identify and gather information about community resources
• Knowledge of industry regulations and legislation
• Able to develop, implement and manage clinical programs
• Able to establish, implement and evaluate client-centered goals
• Basic knowledge of health care economics and health care management
• Good communication skills (for acting as a liaison between different groups, such as doctors, insurance companies, etc.)
Characteristics Needed to Become a Managed Care Nurse
In order to enjoy performing the duties of a managed care nurse, you need to have certain personality traits. Taking enjoyment from your duties as a managed care nurse is important, as it helps you maintain a positive attitude towards your work, which usually leads to having a long and successful career.
• You have tact, professionalism, empathy and patience
• You have an interest in helping keep health care costs low for vulnerable sectors of the population
• You have an interest in ensuring that people from vulnerable sectors of the population receive quality health care
• You have an interest in working in a patient-facing and managerial capacity
• You would enjoy acting as a liaison between different groups (including doctors, patients, health care providers, etc.)
Certification Requirements
To become licensed as a managed care nurse in Canada or the United States you must first be licensed as a Registered Nurse (RN) or a Licensed Practical Nurse (LPN). There is also a voluntary licensing credential available from the American Association of Managed Care Nurses: the Certification in Managed Care Nursing (CMCN) designation.
In addition to being licensed as an RN or an LPN, candidates must write an examination, passing which demonstrates they meet an acceptable minimum level of basic knowledge of the following components: Managed Care Overview, Health Care Economics, Health Care Management and Patient Issues.
Typical Salary Level
The actual wages and salaries of managed care nurses can vary greatly, typically depending on the following factors:
• Their level of education and experience
• The amount of responsibility inherent in their job
• Whether they work part-time or full-time hours
• The structure of their financial benefits package, if they have one
• The region in which they work
• Their salary negotiating abilities
• Many other factors
Managed Care Nurse Salary in Alberta: According to the 2019 Alberta Wage and Salary Survey, the average salary level of Albertans working in the “Registered Nurse” occupational group is $70,429 per year.
Salary - British Columbia: According to WorkBC (Province of British Columbia), those working in the “Registered nurses and registered psychiatric nurses” occupational group earn an annual provincial median salary of $79,040.
Salary - United States: According to the U.S. Bureau of Labor Statistics, the median salary level of Americans working in the “Registered Nurses” occupational group is $71,730 per year.
Who Employs Managed Care Nurses?
Managed care nurses are employed on a part-time, full-time, or contractual basis (primarily in countries with privatized healthcare, such as the United States) by the following types of organizations:
• Hospitals and other health care facilities
• Health plan providers and vendors
• IRO/EQRO or accreditation organizations
• Managed care organizations
• Telephone triage centres
Current Job Postings
Our job board below has "Managed Care Nurse" postings in Canada, the United States, the United Kingdom and Australia:
Similar Occupations in Our Database
Listed below are careers in our database that are similar in nature to Managed Care Nurse, as they may involve many of the same skills, competencies and responsibilities.
• Licensed Practical Nurse (LPN)
References
Please consult the references below to find more information on the various aspects of a career as a managed care nurse.
Occupations in Alberta: “Registered Care Nurse.” (April 11, 2014). ALIS website - Alberta Learning Information Service. Retrieved February 25, 2020.
Explore Careers: “Registered nurses and registered psychiatric nurses.” (December 11, 2018). WorkBC website - Province of British Columbia. Retrieved February 25, 2020.
Healthcare: “Registered Nurses.” (September 4, 2019). Occupational Outlook Handbook - United States Bureau of Labor Statistics website. Retrieved February 25, 2020.
Specialty: “Managed Care Nurse.” (n.d.). Johnson & Johnson website. Retrieved December 31, 2019.
Nursing: “Journal of Managed Care Nursing.” (n.d.). American Association of Managed Care Nurses website. Retrieved December 31, 2019.
Scholarships for Becoming a Managed Care Nurse
Scholarships in Canada and the United States listed for majors that are relevant for becoming a managed care nurse can be found on our Nursing Scholarships page.
Success Tip: Be sure to apply for any scholarships that you even barely qualify for, as there are millions of dollars of scholarships that go unused every year due to a lack of applicants!
Relevant University Majors
Studying one of the university majors listed below is an excellent starting point for getting into this line of work. Click on the links to find out what else you can do with these majors!
