WHAT IS THE AMERICAN BOARD OF MANAGED CARE NURSING?

The American Board of Managed Care Nursing (ABMCN) was formed in 1998 and is a non-profit 501(c) 6 organization. The ABMCN certification program offers nurses at health plans, hospitals and provider systems, licensed social workers at managed care organizations and licensed professional counselors at managed care organizations a national examination testing competence to deliver a defined set of behaviors related to patient-centered care to member populations in managed care. The ABMCN examination has been developed and reviewed by nurses with practical experience in managed care and peer acceptance as nurse leaders.

THE VALUE OF CERTIFICATION

Nurses, social workers and licensed counselors are in excellent positions to take advantage of the changes occurring in the health care delivery system. The education and professional philosophy of your vocation makes our profession especially qualified to make the changes needed to move a patient population from a paradigm of medicine to a paradigm of health. The certification process of ABMCN promotes excellence and professionalism in managed care nursing and care management and recognizes individuals who demonstrate an acquired body of knowledge and expertise in managed care through voluntary certification. Candidates who pass the examination may use the initials CMCN (Certified Managed Care Nurse) or CMCP (Certificate Managed Care Professional) as part of their professional signatures. Download a brochure here.

PHILOSOPHY OF MANAGED CARE NURSING

Webster defines nursing as "a nurse’s occupation or task; one who is educated and licensed to care for the sick or disabled in collaboration with other health care providers."

 

The managed care professional is required to function in many different settings and roles. In contrast to the traditional role of the nurse to provide direct patient care at the bedside, the current role is to advocate for all patients enrolled in healthcare delivery systems, to administer benefits within the confines of the healthcare delivery system and to provide customer service for all of the encounters with members of the healthcare delivery system.

 

Managed care nurses, social workers and counselors develop and implement a variety of programs which may include wellness and prevention programs, disease management programs, quality management programs, and demand management programs. This enables the managed care nurse/social worker/counselor to foster a proactive approach that involves the patient in the management of his/her individual health care needs. By utilizing a self-healthcare approach, the goal of the patient is to have a better understanding of matters relating to his/her health, to maintain a more active life-style, and to have mental well-being.

This role in managed care moves along the continuum from direct patient care to administration. Employers of the near future will recruit nurses/social workers/counselors who understand the overall structure of the healthcare industry, who possess highly developed critical-thinking skills, and who bring to their positions a well-rounded understanding of the risks and benefits of every healthcare decision. 

 

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

 For more information email Jackie Beilhart at jbeilhart@abmcn.org