Every patient deserves the highest standards of medical care at a rate that they can afford. This often requires navigating the intricacies of the health care system, different insurance providers and public health benefits. To help keep care as accessible as possible and ensure that health organizations run at peak efficiency, hospitals and health systems are increasingly employing directors of managed care.
This critical leadership position is responsible for managing the relationships between health care providers and insurance companies. For those who wish to realize success in this field, pursuing an advanced education in health administration can be helpful.
What Does a Director of Managed Care Do?
To get a better sense of the definition of managed care and its roles and responsibilities, explore a basic overview of the position and a typical job description.
Managed Care Definition
Managed care involves prepaid health plans that deliver patient care through a network of providers. The goal of managed care is to make treatment and preventive measures more affordable for patients while allowing health care organizations to have greater budgetary control.
Managed Care Job Description
A director of managed care is responsible for ensuring that patients receive the highest level of care; this is accomplished through negotiations between providers and health insurers. While the day-to-day duties and responsibilities can vary, a typical job description looks something like this:
- Verifying insurance details
- Analyzing financial transactions
- Negotiating contracts with medical suppliers and organizations
- Developing policies to improve delivery of care
Managed Care Work Environments
These professionals work across a variety of settings and workplaces, including hospitals, health insurance companies, nursing homes, long-term care facilities and managed care organizations. Managed care positions can be found in virtually any organization that plays a direct role in determining the level of care available to patients.
How to Become a Director of Managed Care
Those who wish to attain this important health leadership position need to build the right background, skills and experience. This can be accomplished through a combination of formal education and hands-on experience.
Core Qualities
The essential qualities for success as a director of managed care include the following:
- Experience in health care management. The role typically requires a background in health management, including experience managing personnel in different types of health organizations.
- Negotiation and communication skills. Success in the role hinges on the ability to communicate the needs of a patient or an organization clearly and to persuade suppliers and health organizations to provide the most advantageous terms.
- Familiarity with regulations. A good director of managed care will have a keen awareness of the regulatory environment, promoting patient safety and helping their organization to maintain legal compliance.
Career Trajectory
To hone these and other key qualifications, follow these basic steps.
- Obtain an undergraduate degree. A bachelor’s degree helps students build out core leadership skills and understand the foundational principles of health care management. This may be in any field related to health administration or insurance.
- Pursue experience. It’s also imperative to gain hands-on experience in managed care. This can include entry-level and mid-level roles in insurance and billing departments. Examples of positions to consider include medical billing and coding assistants and insurance associate roles.
- Seek advanced education. Earning a master’s degree in health administration or a related field can allow for further development of managerial skills and regulatory competencies. An advanced degree, such as USC Price’s Executive Master of Health Administration (EMHA), can also lead to higher salaries and more career opportunities.
- Gain certification. While certifications aren’t always required for managed care positions, they can offer additional expertise and potentially lead to higher salary ranges and positions. Two common certifications are the Certified Manager Certification and the Certified Specialist Managed Care certification.
Director of Managed Care Salary
Directors of managed care make a median salary of approximately $123,000 as of March 2023, according to the career and compensation resource Payscale. Factors that can influence the salary include years of experience in managed care, level of education and geographic location. The size and type of organization may also have some bearing on the director of managed care salary.
Further Your Career in Managed Care
Working in managed care helps ensure that those in need of affordable care receive it while also allowing health organizations to operate with fiduciary responsibility and proper budgetary control. Professionals with a passion for patient care who are gifted at communication and negotiation can thrive in this key leadership role.
A good way to prepare for long-term success is through obtaining an advanced education. USC Price’s EMHA provides a flexible online option for senior managers to strengthen their core leadership skills and health care competencies. Explore the program today to find out how USC can create a solid foundation for long-term success as a director of managed care.
Recommended Readings
7 Reasons to Pursue an EMHA Degree
6 In-Demand Health Administration Careers
5 Ways an EMHA Can Advance Your Health Care Career
Sources:
Centers for Disease Control and Prevention, “Managed Care”
Indeed, “Health Care Administration Skills (Plus How to Improve Them)”
Payscale, “Average Director of Managed Care Salary”
Zippia, “5 Best Managed Care Director Certifications”
Zippia, “Managed Care Director Overview”
Zippia, “What Does a Managed Care Director Do?”