Manganese (Mn) has attracted widespread attention due to its low-cost, nontoxicity, and valence-rich transition. Various Mn-based nanomaterials have sprung up and are employed in diverse fields, particularly Mn-based nanozymes, which combine the physicochemical properties of Mn-based nanomaterials with the catalytic activity of natural enzymes, and are attracting a surge of research, especially in the field of biomedical research. In this review, the typical preparation strategies, catalytic mechanisms, advances and perspectives of Mn-based nanozymes for biomedical applications are systematically summarized. The application of Mn-based nanozymes in tumor therapy and sensing detection, together with an overview of their mechanism of action is highlighted. Finally, the prospective directions of Mn-based nanozymes from five perspectives: innovation, activity enhancement, selectivity, biocompatibility, and application broadening are discussed.