What Does a Managed Care Manager Do?

what-does-a-managed-care-manager-doA Managed Care Manager is a health care professional who helps control costs and improve quality. These managers will work with:

  • insurance providers
  • health care organizations
  • financial services

We explain below what these managers do and why they are so important to the health care system.

What is Managed Care?

Managed health care refers to a set of techniques designed to reduce health care costs and increase quality of care. This will involve a designated group of doctors and health care organizations, known collectively as a provider network. It  provides health care services to patients. There will be:

  • detailed provider selection requirements
  • an official utilization review program
  • a quality improvement system

Managed care will always involve financial incentives to encourage providers to effectively use resources.

What are the Benefits of Managed Care?

The goal of managed health is to reduce operational costs through negotiating better fees, only using cost effective providers and offering financial incentives. Managed care organizations (MCOs) encourage patients to use their in-network providers through charging very high fees. However, MCOs also offer proactive programs designed to reduce costs and increase patient health. For example, these programs include wellness incentive programs, which encourage patients to independently track and improve their health. They include patient education programs, which focus on disease prevention and awareness.


What Does an Entry-Level Managed Care Manager Do?

These managers work in entry, mid and senior level positions and perform a variety of tasks and functions. For example, entry-level managers may be referred to as marketing, operation and provider assistants. Their primary responsibilities include:

  • marketing
  • operations
  • finances
  • account management

For example, they may conduct health industry research, help sales staff and help out with short-term projects. The education requirement for entry-level managers is an undergraduate business or healthcare degree in something like marketing of health services management.

What Does an Mid-Level Manager Do?

These professionals may act as sales, marketing or department directors. They must have experiential knowledge of:

  • operations
  • health care systems
  • information technology

They must also have excellent analytical, communication and team-building skills. Mid-level managers typically have a master’s degree, such as an MHA or MBA.

What Does an Senior Manager Do?

Senior managers are also known as CEOs or vice presidents. They generally have a master’s degree with at least 10 to 15 years of experience. They will primarily work with insurance, capital and reimbursement regulations. They must have excellent skills in:

  • risk management
  • strategic planning
  • finance

Where Do Managed Care Managers Work?

MC Managers often work for managed care organizations such as:

  • independent associations
  • management services companies
  • physician practice organizations

For example, independent practice associations (IPAs) are a collection of autonomous doctors that provide specific services to health care organizations. They typically set up a flat fee or fee-for-service system. Sometimes, HMOs contract with an IPA, which will then turn around and negotiate customized contracts with independent doctors.

On the other hand, healthcare management services organizations (MSOs) are companies that provide practice management and admin support to other doctors. They are typically owned by a group of doctors or joint venture group. They provide non-medical business services, such as:

  • billing
  • staff benefits
  • malpractice
  • building and equipment rentals

To review, there are different kinds of managed care managers that perform a variety of critical health care supervision and overview. The goal of managed care is to ensure cost effective, quality care for patients. Being a Managed Care Manager is a uniquely rewarding and challenging career.