Job Profile: Managed Care Executive

In the truly changing healthcare industry, managed care executives are essential health plan leaders who supervise the operations of healthcare systems designed to deliver medical services in ways that improve quality and reduce costs. Although executives in managed care often are described as working in the “insurance business,” their functions encompass a wide variety of operations, including assembling a network of health providers to deliver services, marketing services as health plans, processing insurance claims, and evaluating health services.

With a strong external focus, managed care executives have substantial involvement in providing organizational direction, solving business strategic issues, making investment decisions, and improving operational efficiency for overall provider and patient satisfaction. Most executives work in senior-level positions in managed care companies; however, there are also opportunities for employment in healthcare provider organizations like hospitals and medical group systems. Managed care executives may work with proposing health plans in one or all categories of health maintenance organizations (HMO), preferred provider organizations (PPO), or point of service (POS).

Salary

According to the Bureau of Labor Statistics, the average annual salary for managed care executives and other top-level executives is $178,400, which is equivalent to a mean hourly wage of $85.77. On average, managed healthcare executives can receive the highest salaries by gaining employment in insurance brokerages at $234,610 and private corporations at $212,570 each year.

Beginning Salary

As with other careers, managed care executives typically need to work their way up the pay grade, but often will start at a rather high average beginning salary of $75,030. Top-level executives who have additional years of experience in providing overall direction and formulating policies in managed care organizations will often eventually surpass the quarter-million mark in their yearly earnings.

Key Responsibilities

Since managed care executives are granted one of the highest salaries in the booming healthcare industry, it is no surprise that this senior-level position comes with some hefty responsibilities for overseeing the operations and personnel of managed care organizations. In most cases, executives will be responsible for managing all activities of the company, including directing the development of insurance policies, ensuring compliance with healthcare delivery programs, revising policies, establishing critical objectives, reviewing program evaluation reports, approving proposals, identifying a budget, and developing administrative strategies to modify programs in response to changing federal or state healthcare delivery laws. Managed care executives work collaboratively with other members of the executive management team to propose programs that meet all applicable standards on healthcare service plans.

Necessary Skills

In the important leadership position, it is essential that managed care executives possess very strong communication skills for articulating the organization’s mission, effectively discussing issues, negotiating with subordinates, and explaining their policy changes. Since managed care executives organize the operations of the entire organization, leadership, management, decision-making, problem-solving, and time management skills are absolutely required. In the managed care industry, it is also important for top-level executives to have a broad-based understanding of insurance regulations, reimbursement procedures, risk management, strategic planning, operations management, and health information technology.

Degree and Education Requirements

Although education requirements can vary in the healthcare industry, the vast majority of senior-level managed care executives today have earned a graduate degree at the master’s level from an accredited institution. In many cases, managed care executives make the decision to attend business school to earn a Master of Business Administration (MBA) for obtaining essential general management skills that can be applied to the health field. Some aspiring managed care executives may also find earning a Master of Health Administration (MHA), Master of Health Services Management (MHSM), or even a Master of Science in Finance (MSF) as beneficial to successfully building their career towards leadership.

Pros and Cons of the Position

Beyond the awe-inspiring numbers that come with the tremendous salary potential in this position, managed care executives benefit from playing a prominent role in the health insurance field for building contracts with healthcare providers and medical facilities to ensure member patients receive the best services at a reduced cost. However, working as a managed care executive is extremely challenging that comes with hefty decision-making responsibilities that could impact the entire organization. Managed care executives need to have extensive training, work an average of 70 hours per week, and work strictly behind the scenes with no hands-on patient care to handle the business operations of the healthcare field.

Getting Started

Similar to other chief executive positions in other industries, most managed healthcare executives get started on their career path by working in lower-level managerial or supervisory roles to advance within their own firm towards upper-level positions. Whenever possible, it is recommended that you participate in company training programs, executive development courses, and certification opportunities to facilitate your promotion. Many managed care executives choose to maximize their professional potential by becoming board certified through the prestigious American College of Healthcare Executives (ACHE) once they have achieved a minimum of two years of experience in a healthcare management role. Typically, managed care executives have at least ten years of progressive management experience before assuming the position to fully understand the positioning of products and services in the marketplace.

Future Outlook

Due to the recent changes in federal regulation in the Affordable Care Act, managed care executives are expected to enter a very competitive marketplace as companies are suffering low-profit margins, rising medical expenses, and continual pushes for consolidation. That being said, managed care organizations will be seeking to hire more executive-level managers to develop effective policies for careful pricing to help improve profits and cut costs. Since top executives will be essential for running managed care companies towards success, the employment of executives is expected to grow at a decent rate of 11% before 2022. For the best job prospects, it is recommended that executives earn an advanced degree, acquire extensive managerial experience, and build strong leadership abilities.

While becoming a managed care executive is certainly challenging, there are many rewarding features to this leadership position that include recognition among colleagues, room for advancement to the top, and a high salary potential. Pursuing this career will not happen overnight, but with hard work, extensive managerial training, and proven results you can achieve the role of managed care executive.

Leave a Reply