Jobs in the healthcare administration field vary considerably. You can choose to work in smaller facilities that demand a hands-on approach. Or, you can train for a bigger-picture career managing people from afar. The concept of managed care administration might bring to mind a desk-bound executive doing paperwork. Yet, that's not always the case. Managed care is an in-demand field that involves strategic thinking and collaboration.
With longer lifespans and an aging population, healthcare administration is on track for major growth.
Below, we’ll take a look at the managed care administration career path from education and potential roles. We'll also look at salary and job prospects from the entry-level up to senior exec.
What is Managed Care Administration?
Managed care is a strategic public health role—defined as health insurance which creates contracts with specific providers in order to pass on group savings to members (patients). Most managed care plans are Health Maintenance Organizations, or HMOs. People who work for HMOs put together health plans and negotiate set rates per person with healthcare purchasers and providers.
This area of healthcare aims to improve how healthcare benefits are delivered. If you live in the US and have health insurance, chances are, you are part of a managed care program. Managed care involves a lot of negotiating. Providers want to see profits, while patients need something affordable.
Contracts are in place so that medical facilities and administrators are able to provide care to members at reduced costs. Executives in the managed care work on the border of insurance and healthcare.
They might work at a managed care network or with a state or local government. In some cases, large medical organizations have their own managed care team working internally. In any case, you’ll have a lot of contact with insurance providers, physicians, and hospital administrators.
At its core, managed care is all about money management. Administrators process claims, assemble and maintain a network of providers. They cobble together various health services and market them as a health plan. Finally, managed care evaluates said services, seeking ways to cut costs and improve patient satisfaction. All these functions might exist in one organization, or span a network of several facilities.
With changes facing the industry and the role of Medicare/Medicaid, expect to see a shift in managed care’s role. These days, employers are moving more workers to high-deductible plans, putting more costs on employees. As such, what insurers cover will likely remain in the realm of managed care.
Additionally, some managed care plans focus on improving community health. In this case, administrators coordinate flu shot reminders, encourage wellness checks, and emphasize disease prevention.
Relationship building is also central to managed care. You’ll need to have contacts all over the healthcare industry—and you’ll need to be a persuasive communicator. This department also handles marketing health plans and creating messaging that connects with the patient community. Finally, quality control, financial services, and processing claims also come into play.
As you can see, managed care is a complex role with no shortage of things to do. This role makes most sense for a person who is a skilled communicator, a strategic thinker, and who has a good handle on finance.
Managed Care Administration Education Requirements & Certifications
There is a range of career options that fall under this broader, managed care umbrella. As such, there’s some variability in the educational requirements needed to get started in this business. While some entry-level positions only require an associate’s degree, managed care is a strategic area. As such, leveling up your educational achievements can open up greater possibilities.
Here’s a look at what your education path might look like if you’re interested in managed care:
Bachelor's Degree for Managed Care Admin
Getting a bachelor's degree may help you get your foot in the door early in your career, but you'll need to choose a relevant area of study. A bachelor's degree in healthcare or business administration will prepare you for related roles. You'll also get some background in marketing, quality assurance, and management.
Programs will vary by institution and state. In most cases, students learn about public policy, finance, marketing, management, and public health. Additionally, students will study communications, as they pertain to healthcare relationships. This includes payor relations, as well as communications with patients and hospital staff.
Students can bolster their college experience with internships in healthcare. Or, they can take part in labs preparing them for real-world challenges. While a bachelor's degree might not prepare you for a fast-track executive career, you'll have plenty of prospects.
Managed care coordinators can enter the workforce with a bachelor's degree. Ideally, the degree is in health administration, business, or another related field.
In some cases, students may choose to earn an associate's or bachelor's degree and for a master's degree after logging some time on the job.
Master’s Degree for Managed Care Admin
Managed care organization administrators often come from a diverse background. Students come to this field with existing healthcare experience. Others may have a background in business administration, marketing, accounting, or finance.
The advantage in pursuing a health administration degree is the deep dive into the legal, financial, and managerial aspects of healthcare. Again, you may work in this field without a master's degree and do quite well. However, if you want to open the doors to a director position or get on the executive track, the MHA is a worthwhile investment.
Master’s degrees in health administration prepare students for high-level admin positions in a hospital setting, managed care organizations, and more.
Although education requirements vary in the industry, a good chunk of senior management has an advanced degree. Often, aspiring executives choose to pursue a Master of Business Administration (MBA) to learn general management skills.
The other option is seeking a more specific path. Earning a Master of Health Administration (MHA) or Master of Health Services Management (MHSM) may better prepare students for this particular career path.
Additionally, many of these programs, whether it's a Master of Public Health or a Master of Health Administration involve completing some thesis or capstone project. There, students can create an opportunity to focus on managed care.
Potential Roles in Managed Care
The managed care career path presents a wide range of career opportunities at every level. Here's a look at some of the possible roles, from the entry level to senior management roles.
Managed Care Coordinator
Managed care coordinators are responsible for communications between patients, medical facilities, and insurance companies. In this role, you'll be responsible for authorizing medical services and following all privacy and regulatory guidelines. Coordinators manage patient records according to industry standards.
Coordinators are responsible for many of the day-to-day operations. Working to ensure that communication runs flows between all involved parties. Managed care coordinators deal with insurance claims, authorizing services and handling patient billing processes.
Mid-Level Careers
At the entry level, you'll start by working as a managed care coordinator or somewhere in the sales or marketing department. As you progress in your career, more options open up. Think department managers, director or marketing or sales, or managers of ancillary services.
If you have a background in nursing or social work, a career as a case manager is a possibility. Or, you can become a specialist that negotiates contracts with payors and providers.
Director of Managed Care
Managed care directors are responsible for setting up commercial payor accounts and maintaining relationships with those companies. These folks manage a team—including
In this role, you'll need a bachelor’s degree. You must also have at least 3 years of experience in the healthcare industry. Ideally, you have experience with managed care contracts, billing, and claims issues. The ability to function as a liaison between the healthcare facility and the insurance providers is a big plus.
That said, candidates with a master’s degree may fare better than the competition.
Directors of managed care must balance customer satisfaction and with negotiating payor contracts. The candidate should have business development skills, know all relevant administration tasks, and experience running operations in a managed care environment.
In this role, you can expect to handle a lot of the contracting responsibilities and payor relations. You'll negotiate contract terms, update language provisions and set rate strategies. You'll plan and interpret contracts, develop new policies, set goals and help your team meet objectives.
You'll renegotiate contracts and develop new terms based on contract goals and parameters.
You'll work with senior executives making policy recommendations and coming up with new contracting strategies.
Managed Care Executives
At the senior level, positions include CEO, CFO, VP, etc. At this level, the applicant usually holds a master’s degree and has over 10+ years of management experience.
In the executive role, the applicant must have a proven track record of managing operations and personnel. They'll also need direct experience in developing policies, ensuring compliance, and developing organizational strategies.
Execs work to establish programs according to changing legislation. They'll work with a larger team to propose new programs that work for patients and payers alike.
Certification or Continuing Education Requirements
Like other industries, managed care executives often work their way up from lower levels to managerial roles. If possible, take advantage of certification opportunities, further training, and development courses. These opportunities allow you to stay up-to-date on policy changes and new technology, as well as present an opportunity to network.
After achieving two+ years of experience in a managed care role, executives can set themselves apart with a certification from the American College of Healthcare Executives (ACHE). This association grants certification to qualified members who wish to advance to “fellow status.” You’ll need a recommendation and are on the hook for a $250 application fee and a $200 examination.
While ACHE only certifies experienced members, entry level administrators can take classes through the organization. The site also provides a wealth of information useful at every career level.
Managed Care Administrator Salary and Career Outlook
The Bureau of Labor Statistics (BLS) reports managed care administrators earn a median salary of $98k on an annual basis. Earning potential varies based on experience, education, and the size of the organization. That said, there is some disparity by organization. The American College of Healthcare Executives states that managed care professionals usually earn between $50k and $70k.
At the senior level, executives can expect to earn more. Average salaries range from $150k-$250k, on an annual basis. And, in some cases, that number can get substantially higher, with the addition of stock options and bonuses.
Again, a master’s degree is optimal in this field, as there’s a lot of competition in this space, especially at the executive level. Still, there's plenty of room for growth with a bachelor's degree, as a mid-level manager or director can earn six figures.
The future of managed care is bright. As the baby boomer generation ages, strategic healthcare professionals will be in high demand.
This demand means all jobs within the healthcare industry are bound to be in high-demand. We’re talking nurses, doctors, and the administration there to make sure everything runs smoothly.
In the end, those people who choose a path in healthcare administration can expect a rewarding career with high earning potential. Applicants will often start out as a manager of a specific department and gain experience. Later in their careers, they may have the option to advance to executive roles overseeing entire facilities.
With the Affordable Care Act and the changing healthcare space, managed care executives will likely be in demand for the long haul. Executive-level managers in demand. New policies with careful pricing structures are needed to increase profits while cutting costs.
To enhance job prospects, you'll need to gain ample managerial experience, negotiation skills, and be a strong leader. An advanced degree can sweeten the deal, too.
Becoming an executive is a challenging path. But, a career in managed care provides an opportunity for a rewarding career heavy on problem-solving and relationship building. And room for growth, too.
Managed care often tends to reduce or remove people' rewards to overuse services. It typically minimizes person out-of-pocket costs and other monetary obstacles to healthcare. Managed care likewise has the possibility to accomplish far better synchronisation of patient solutions. Given that a lot of managed care organizations make use of the primary care physician to direct as well as structure the patient's complete treatment, in theory the solutions offered should be a lot more sensible, tailored, and also punctual than they would certainly be under various other systems. Managed care, with its use of interior computer details systems, likewise has the prospective to monitor the quality of care and examine the efficiency of both specific people and their doctors a lot more efficiently.
Lastly, some managed care companies supply transportation services for individuals between their homes and also the facilities where they get care. These solutions might be crucial for people with major disabilities, particularly those that reside in locations with no public transport. Managed care, nonetheless, also presents a number of powerful problems. For example, managed care companies may develop and also guide their marketing programs to bring in just generally healthy and balanced populaces.
They might overtly and also secretly discourage enrollment of people that are most likely to be individuals of pricey healthcare services. Because people with impairments as well as chronic disease might be frequent customers of experts as well as other high-cost medical services, managed care organizations might view them as undesirable individuals.
On top of that, managed care companies commonly make use of primary care physicians as "gatekeepers" to manage accessibility to care. These doctors may not have the required experience or competence to attend to the distinct requirements of people with varied physical and also psychological disabilities.
With their focus on health care and price control, managed care organizations might not give individuals with special needs, persistent illness, or psychological injury appropriate access to needed professionals that are certified to diagnose and also treat their problems.
For example, managed care organizations may quit referrals to psychiatrists, that tend to supply even more thorough therapy than other psychological wellness professionals. In addition, the complexity of managed care companies' reference procedures and issues as well as grievance procedures, and also the materials that explain these facets of managed care, may produce incredible barriers for people with cognitive or discovering disabilities.
Since managed care companies deal largely with the requirements of healthy and balanced people, they may make use of interpretations of "clinical requirement" that antagonize some individuals. For example, they might use requirements that ask for "considerable improvement" or "restoration of feature" as problems for the permission of therapy, medication, or clinical tools.
This might discriminate against individuals with particular types of physical or psychological impairments that can not satisfy these standards.Managed care organizations likewise might have slim short-term organisation point of views that eventually lead to choices that hurt clients. Since much of these organizations operate on a for-profit basis therefore needs to create an ideal return on equity to their proprietors or investors, managers might be under wonderful pressure to hold back short-run prices. To do so, they might reject people access to ongoing ancillary solutions, such as speech, physical, and work-related therapies, or they might keep pricey clinical tools from individuals who need them. These clients might experience in the long term as a result of these shortsighted choices.
Managed Care describes the protection and monitoring of health care for seniors and those with disabilities. That's an extremely wide umbrella, which uses a wide range of career options for the healthcare sector. This is an ever-expanding field, with even more individuals being detected with conditions and needing medical care in lots of areas. Managed Care jobs are more probable to provide full benefits than traditional health care tasks, but the salary for Managed Care Positions is still considerably higher than many occupations in the healthcare industry.
The growth of the healthcare sector has actually created a scarcity of certified healthcare employees that have the skills to take care of the boosting numbers of seniors and also grownups with special needs. Managed Care Positions has an expanding requirement for competent employees that can give the high quality like these susceptible populaces.
Healthcare professionals that work in this area ought to have the ability to use patients and households as well as their caregivers innovative services to assist them in preserving healthy and balanced behaviors, while addressing the detailed demands of their people. Caretakers, also, need to obtain the assistance they require from an entire division of physicians.
Clinical workers that do their medical work in Managed Care environments have a high degree of task complete satisfaction and occupation stability. This is because of the truth that they have a high level of control over their daily lives, in addition to the healthcare solutions provided to them.
Managed Care sectors are readily available in all areas of the country. There are several benefits to picking a Managed Care setting, instead of a traditional health care task. Nevertheless, Managed Care Positions are not without their obstacles, either.
Many medical care specialists who work in Managed Care Positions will have a less requiring schedule than some other work. Managed Care settings consist of even more travel possibilities than standard health care tasks, as well as normally allow health care specialists to continue operating in the same location as their existing task. Several Managed Care Positions additionally provides greater compensation than standard healthcare work.
Managed Care Positions may not be for everyone, nonetheless. A Managed Care Job is more like being a part-time health care setting. With the extra responsibility of supplying health care to seniors as well as other prone populations, Managed Care Positions additionally requires a great deal of responsibility for the medical professionals that work in the setting.
As a Managed Care Healthcare Employee, it is important to remain unbiased as well as stay concentrated on giving high quality care. This is the reason that a lot of Treatment Positions need a more intensive level in healthcare self-control, along with at the very least one year of specialized training.
The majority of healthcare suppliers that provide Managed Care Services do so as a part-time service, which implies they need to provide solutions as required by their customers, that are in some cases elderly or literally challenged. Managed Care Programs are commonly used by area facilities, however they are also supplied in retirement communities, helping living facilities, health centers, nursing homes, and other facilities that deal with elders.
Those that operate in a Managed Care Health care Environment are required to accept a certain quantity of blame for any kind of mishaps that take place within the facility. It is a very managed Sector, so there are typically regulations to maintain doctors in check. Managed Care Providers additionally have to abide by rigorous requirements concerning making use of medications as well as various other drugs, along with the medication dosages for the team as well as the patient.
The very best doctors that have an interest in a Managed Care Job should explore the certain needs for the program before devoting to it. Be sure to likewise talk to your local health and wellness department to find out if there are any specific licensing requirements that you need to fulfill so as to get begun in the Managed Care Sector.
If you have constantly wanted to assist individuals, then Managed Care might be right for you. A Managed Care Work will enable you to utilize your clinical knowledge to offer others, while earning a comfortable income for yourself. If you really feel that you would rather go after a normal permanent setting, then a Managed Care Job is additionally perfect for you.