CMCN Exam Information and Outline
Certification in Managed Care Nursing
Syllabus Update Checked on: November 12, 2026
CMCN Exam Syllabus & Study Guide
Before you start practicing with our exam simulator, it is essential to understand the
official CMCN exam objectives. This course outline serves as your roadmap.
The information below reflects the 2026 syllabus defined by
ABMCN.
Below are complete topics detail with latest syllabus and course outline, that will help you good knowledge about exam objectives and topics that you have to prepare. These contents are covered in questions and answers pool of exam.
SECTION ONE: Managed Care Overview
Possess an overview of Managed Care
Understand the spectrum of roles for nurses in managed care
Describe the history of healthcare as it relates to the development of Managed Care
Identify significant milestones, concepts and laws
Understand the constant evolution of Managed Care
Identify different types of government coverage & products
Identify some of the benefits of governmental managed care products
Recognize and describe the major components of and differences within government managed care models
Identify types of commercial managed care products
List examples of commercial managed care product coverage & benefits
Describe major components of and differences within commercial managed care models
SECTION TWO: Healthcare Administration
Define negotiation, why it matters, and its parts
Identify tools to use/develop for successful negotiation
Understand how to prepare for a negotiation
Identify how to have a successful negotiation in the healthcare environment
Define basic managed care reimbursement terminology
Explain the relationship between types of provider reimbursement
Identify trends in reimbursement methodologies
Understand impacts on care delivery and outcomes
Describe the history of health information technology
Identify the use of medical and clinical informatics in managed care
Discuss the nurse’s role in health information technology and informatics
SECTION THREE: Healthcare Management
Identify and define the multiple components of a utilization management program
Compare the elements of the utilization management process
Compare the elements that comprise the quality management/improvement process within utilization management
Recognize the fundamentals of utilization management and quality management/improvement as they impact the delivery of cost-effective quality care
Recognize the current accreditation bodies
Understand the implications of accreditation
Know how accreditation affects managed care
Identify how provider profiling can summarize practice patterns that lead to improved provider performance
Explain why reliability measurement is an important component in evaluating a profile system
Examine the effect of provider profiling on the quality of care and disease management
Describe the fundamentals of Quality Management and improvement programs
Identify basic quality improvement principles and activities used in a managed
care setting
Understand the importance of quality performance
SECTION FOUR: Law & Ethics
Identify various laws and rules that affect the managed care nurse’s role
Describe the managed care nurse’s role in maintaining compliance and managing risk
Identify methods of dispute resolution
Describe the differences between principles, values and ethics
Describe the ethical decision-making model of nursing
Discuss pertinent issues from an ethical perspective