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WHAT IS THE AMERICAN BOARD OF MANAGED CARE NURSING?

The American Board of Managed Care Nursing (ABMCN) was formed in 1998 and is a not-for-profit 501(c) 6 organization. The ABMCN certification program offers nurses and social workers a national examination testing competence to deliver a defined set of behaviors related to patient-centered care to member populations of health plans. The ABMCN examination has been developed and reviewed by experts with practical experience in managed care and peer acceptance as managed care leaders.

THE VALUE OF CERTIFICATION

Nurses and social workers are in an excellent position to take advantage of the changes occurring in the health care delivery system. The professional philosophy of nursing makes our profession especially qualified to make changes needed to move managed care organizations from a paradigm of medicine to a paradigm of health.

The certification process of ABMCN promotes excellence and professionalism in managed health care 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 (Certified Managed Care Professional) as part of their professional signatures.  This process begins with either completion of the American Association of Managed Care Nurses (AAMCN) “Introduction to Managed Care Nursing” home study course or an affidavit stating completion of similar curriculum. For information on the home study course please
click here.

PHILOSOPHY OF MANAGED CARE NURSING

Managed care nurses are a valued resource utilized by many organizations such as health care institutions, health plans, IRO/EQRO or accreditation organizations and health care providers/vendors to ensure improved coordination and positive outcomes of clients’ care. They ensure that desired clinical outcomes can be achieved in a cost-effective manner that ultimately supports the client, the organization, and ultimately the delivery of health care.

 
The managed care nurse practices in a variety of  settings and may work directly with their clients/caregivers and providers, acting as a liaison be­tween the professional and facility providers, the managed care organization (MCO), and community agencies.  They may also practice in settings delivering  direct member care, particularly those organization assuming financial or clinical outcome risk such as in population management health programs or in compliance  or accreditation organizations.

 

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

The nurse's role in managed care moves along the continuum from direct patient care to administrator. Employers of the near future will recruit nurses 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.

PHILOSOPHY OF SOCIAL WORKERS IN MANAGED CARE

The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilizing theories of human behavior and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work.

Many work in connection with managed care nurses in Case Management, Utilization Management and Quality Management to improve the outcomes of a specific population.

 For more information email Rene Enders at renders@abmcn.org

 

 
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