Managed Care Executive Job Description [Updated for 2025]

In today’s healthcare landscape, the role of managed care executives has become increasingly crucial.

As the healthcare industry evolves, the demand for strategic, competent leaders who can effectively manage healthcare delivery systems and ensure optimal patient care continues to grow.

But let’s delve deeper: What’s really expected from a managed care executive?

Whether you are:

• A job seeker aiming to understand the core responsibilities of this role,
• A hiring manager outlining the perfect candidate,
• Or simply curious about the intricacies of managed care executive roles,

You’ve come to the right place.

Today, we’re presenting a customizable managed care executive job description template, designed for seamless posting on job boards or career sites.

Let’s dive right in.

Managed Care Executive Duties and Responsibilities

Managed Care Executives play a crucial role in the healthcare sector by overseeing the development and implementation of healthcare programs and managing relationships with various healthcare providers.

They are responsible for improving the quality of care and services, while also ensuring cost-effectiveness.

The main duties and responsibilities of a Managed Care Executive are:

• Develop and implement strategic plans for managed care programs
• Oversee and manage relations with healthcare providers, insurers and other stakeholders
• Ensure compliance with laws, regulations and contractual agreements related to managed care
• Analyze data related to healthcare costs, utilization patterns, and quality of care
• Identify potential improvements in the delivery of care and services, and implement changes as necessary
• Negotiate contracts with health care providers and insurers to ensure cost-effective care
• Monitor managed care performance and generate reports for senior management
• Coordinate with other healthcare professionals and departments for the efficient operation of the managed care program
• Manage dispute resolutions between patients, providers, and insurers
• Stay informed about the latest developments in healthcare legislation, regulations, and industry trends

 

Managed Care Executive Job Description Template

Job Brief

We are seeking a highly skilled Managed Care Executive to join our healthcare team.

The Managed Care Executive will be responsible for developing, managing, and maintaining relationships with managed care organizations, health systems, and provider groups.

The successful candidate should be knowledgeable about the healthcare industry, managed care models, contract negotiations, and healthcare laws and regulations.

 

Responsibilities

• Develop and implement managed care strategies
• Negotiate contracts with managed care organizations and providers
• Monitor and analyze trends in managed care
• Ensure compliance with healthcare laws and regulations
• Manage relationships with healthcare providers and networks
• Analyze and interpret financial data
• Collaborate with other healthcare executives to develop strategic plans
• Maintain knowledge of current trends and developments in managed care
• Provide leadership and guidance to managed care teams

 

Qualifications

• Proven experience in a managed care executive role
• Knowledge of healthcare laws and regulations
• Strong negotiation skills
• Ability to analyze and interpret financial data
• Excellent communication and leadership skills
• Ability to build and maintain relationships with healthcare providers and networks
• Bachelor’s degree in Business Administration, Health Administration or related field
• Master’s degree in Health Administration or related field preferred

 

Benefits

• 401(k)
• Health insurance
• Dental insurance
• Life insurance
• Retirement plan
• Paid time off
• Professional development opportunities

 

Additional Information

• Job Title: Managed Care Executive
• Work Environment: Office setting with occasional travel required for meetings with healthcare providers and networks.
• Reporting Structure: Reports to the Chief Executive Officer.
• Salary: Salary is based upon candidate experience and qualifications, as well as market and business considerations.
• Pay Range: $120,000 minimum to $200,000 maximum
• Location: [City, State] (specify the location or indicate if remote)
• Employment Type: Full-time
• Equal Opportunity Statement: We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
• Application Instructions: Please submit your resume and a cover letter outlining your qualifications and experience to [email address or application portal].

 

What Does a Managed Care Executive Do?

Managed Care Executives work in healthcare organizations, primarily in insurance or healthcare provider networks, to oversee the strategic and daily operations of managed care services.

Their primary role is to develop, implement, and oversee policies and programs that ensure affordable and high-quality healthcare services for members.

This often involves coordinating with healthcare providers, negotiating contracts, and making decisions about healthcare cost management.

Managed Care Executives also work closely with other healthcare administrators, healthcare providers, and stakeholders to create care plans that meet the health needs of their members while minimizing costs.

They establish network standards and guidelines and ensure compliance with healthcare regulations and laws.

In addition, they are responsible for analyzing and interpreting data related to healthcare utilization and costs to help improve the efficiency and effectiveness of the care provided.

Managed Care Executives often have responsibilities in areas of strategic planning, business development, and financial management.

They are accountable for maintaining a balance between the healthcare organization’s financial sustainability and the quality of care delivered to the patients.

Finally, Managed Care Executives also play a significant role in handling customer service issues, resolving disputes between healthcare providers and members, and maintaining relationships with partner organizations and regulatory bodies.

 

Managed Care Executive Qualifications and Skills

Managed Care Executives need a combination of healthcare knowledge, leadership acumen and interpersonal skills to effectively manage operations in a healthcare organization.

These skills and qualifications include:

• In-depth understanding of healthcare systems, policies and regulations to ensure compliance and efficient management.
• Strategic planning and decision-making skills to devise and implement operational strategies.
• Strong leadership abilities to guide and motivate teams, fostering a productive and efficient work environment.
• Excellent communication skills to liaise with stakeholders, employees and clients, to discuss plans, address concerns and report on progress.
• Financial acumen to manage budgets, assess financial performance and make cost-effective decisions.
• Customer service skills to understand and cater to the needs of the patients, ensuring their satisfaction and loyalty.
• Problem-solving skills to identify challenges in operations and devise effective solutions.
• Negotiation skills to contract with providers and suppliers, ensuring the best deals for the organization.
• Adaptability to respond and adjust to changes in the healthcare industry and regulations.

 

Managed Care Executive Experience Requirements

Managed Care Executives generally possess at least a bachelor’s degree in Health Administration, Business, or a related field, with a master’s degree preferred by many employers.

Entry-level Managed Care Executives may have 1 to 3 years of experience, often gained through an internship or part-time role within a healthcare or managed care organization.

This could be in roles such as Managed Care Analyst, Managed Care Coordinator, or other related positions.

Candidates with more than 5 years of experience typically have developed their skills and knowledge in roles such as Managed Care Director, Managed Care Manager, or other similar roles.

These professionals will have comprehensive experience in managed care operations, contract negotiation, strategic planning, and financial analysis.

For those with over 10 years of experience in managed care, they are generally considered for senior executive positions.

These roles require extensive leadership experience, strategic planning, and policy development skills.

A history of successfully negotiating contracts and developing relationships with healthcare providers is also crucial at this level.

Overall, the role of a Managed Care Executive requires a combination of education, relevant work experience, and a thorough understanding of the healthcare industry and its regulations.

 

Managed Care Executive Education and Training Requirements

Managed Care Executives generally hold a bachelor’s degree in a healthcare-related field, such as healthcare administration or public health.

An understanding of business and management principles is crucial, so some executives may also have a background in business administration.

Due to the complex nature of the role, many employers prefer candidates with a master’s degree, often in business administration (MBA) or healthcare administration (MHA).

As part of their education, Managed Care Executives gain knowledge of healthcare laws and regulations, medical terminology, health information systems, and health economics.

To enhance their skills and stay updated with industry trends, Managed Care Executives often participate in ongoing professional development programs and workshops.

Some also pursue professional certifications like Certified Healthcare Executive (CHE) or Board Certification in Healthcare Management from reputed institutions.

Work experience in healthcare management, including roles such as a department manager or medical office manager, is typically required.

Finally, as this role involves significant leadership and decision-making responsibilities, strong leadership, communication, and problem-solving skills are also necessary.

 

Managed Care Executive Salary Expectations

The average salary for a Managed Care Executive is $153,791 (USD) per year.

However, the actual compensation can vary significantly based on factors such as the size of the organization, the executive’s level of experience in the healthcare industry, and the region in which the organization operates.

 

Managed Care Executive Job Description FAQs

What skills does a Managed Care Executive need?

Managed Care Executives need to possess a strong understanding of healthcare laws and regulations.

They should have excellent leadership skills to manage and guide their teams effectively.

They also need to have strong communication and negotiation skills for dealing with health care providers and insurers.

Analytical and strategic planning skills are also important in this role, as Managed Care Executives are often responsible for developing and implementing strategies to improve healthcare services while controlling costs.

 

Do Managed Care Executives need a degree?

Yes, a Managed Care Executive typically needs to have a bachelor’s degree in healthcare administration, business administration or a related field.

However, due to the high level of responsibility in this position, many employers prefer candidates with a master’s degree.

They also require several years of experience in healthcare administration, and some positions may require a license or certification.

 

What should you look for in a Managed Care Executive resume?

When reviewing a Managed Care Executive’s resume, look for a degree in healthcare or business administration, along with extensive experience in the healthcare industry.

Experience in managed care, health insurance, or hospital administration is also highly desirable.

Leadership experience is crucial, as is a strong understanding of healthcare laws, regulations, and trends.

Any specialized certifications related to healthcare management can also be a plus.

 

What qualities make a good Managed Care Executive?

A good Managed Care Executive is a strategic thinker who can develop and implement effective plans to manage healthcare costs and improve service delivery.

They should have a deep understanding of healthcare systems, insurance, and law.

Strong leadership qualities are essential as they will lead and manage teams.

They should also be able to negotiate effectively with healthcare providers and insurers.

Finally, they need to have strong analytical skills to understand and work with healthcare data.

 

Is it difficult to hire Managed Care Executives?

Hiring a Managed Care Executive can be challenging due to the specific skills and experience required for the role.

It’s important to find someone with a strong background in healthcare administration, as well as excellent leadership and strategic planning abilities.

Additionally, the candidate should have a comprehensive understanding of healthcare laws and regulations and be able to negotiate effectively with various healthcare providers and insurers.

 

Conclusion

And there we have it.

Today, we’ve unveiled the ins and outs of what it truly means to be a managed care executive.

Surprise, surprise?

It’s not just about managing healthcare services.

It’s about shaping the future of healthcare, one strategic decision at a time.

With our ultimate managed care executive job description template and real-world examples, you’re fully equipped to make a move.

But, why stop there?

Dig deeper with our job description generator. It’s your subsequent step to meticulously tailored listings or enhancing your resume to its finest.

Bear in mind:

Every strategic decision is a fragment of the bigger picture.

Let’s shape that future. Together.

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