Free for HFMA Members
$399 for Non-members


Health Plans
Hospitals and Other Providers
Physicians and Other Practitioners

Career level:

Experienced Professional

Recommended for:

Healthcare Economics
Managed Care
Payer Contracting
Physician Practice
Revenue Cycle

Delivery Method:

QAS Self Study

Advance Preparation:


Field of Study:

Finance: 2.0 hours
Specialized Knowledge: 10.0 hours



Course Availability:

18 Months

Blog | Managed Care
HFMA's Chad Mulvany says it’s imperative that everyone in the U.S. supports safety-net hospitals, or there will be an increase in the disparities in access to basic healthcare services between the haves and have-nots.
Blog | Managed Care
HFMA's Chad Mulvany says although COVID-19 may have "dampened enthusiasm" for Washington state's public option, he is not sure the blame for its slow start rests solely, or even partly, on COVID-19.
Blog | Managed Care
Health plans seeking state legislative help with site-neutral payments will likely find allies among employers who are increasingly frustrated with healthcare costs.
Blog | Managed Care
Employer frustration with high healthcare costs is translating into support for more aggressive governmental intervention in healthcare markets.
Blog | Managed Care
Hospitals and health systems need to be able to deliver high-quality outcomes in a cost-efficient manner to ensure they are not implicitly tiered out of a health plan's network.
Certification | Intermediate | Managed Care

Certified Specialist Managed Care (CSMC)

Certification | Intermediate | Managed Care

Certified Specialist Managed Care (CSMC)


Get recognized as a valued contributor to your organization's financial performance when you earn HFMA's Certified Specialist Managed Care (CSMC) certification.

Those who earn this certification have demonstrated specialist-level knowledge of models, payment rates, benefit coordination, reimbursement, cost-control incentives, legislative changes, and more.

Available online, 24/7, this certification, online program, certification maintenance, and digital badging related costs are all included in HFMA membership.

Course Outline:
Overview of Managed Care
Healthcare Delivery Systems
Managed Care Reimbursement Methodologies
Managed Care: Incentives, Emerging Trends, and Risks
Provider and Payer Infrastructure and Process
Managed Care Contracting and Negotiating
Managed Care: Trends in Case and Utilization Management
Healthcare Industry Regulation and Accreditation
Trends in Healthcare Policy
Essentials of Medicare and Medicaid Managed Care

Assessment information:
The online program includes the course modules listed above and a certification assessment. The assessment has 75 multiple choice questions and you have 90 minutes to complete it in one sitting. The passing score is 70%. If you do not pass the assessment on the first attempt, there is a mandatory waiting period. You'll have access to the exam summary and the course while you wait for your next attempt. The exam summary will show you how you did on the questions from each course module of the online program.

Estimated course completion time: 10-12 hours

If you need to recertify, please click here.

Note: If you are an HFMA member and currently registered for this program and need additional time because it is expired or expiring soon, please email to request an extension.
After this program, you'll be able to..
  • Identify key factors that influenced the development of managed care
  • Explain coordination of benefits, managed Medicare organizations, and TRICARE
  • Identify the clinical integration components of case management
  • List the two main issues to consider when discussing the safe use of EHRs
  • Discuss the potential results of EHR's emphasis in providing one standardized clinical data structure and presentation
Online program last updated: 5/24/2018

Related Courses | Managed Care

On Demand Webinar | Intermediate | Contracting

Understanding the Semantics and Execution in Contract Negotiations

A medical center CEO will explain his role in facilitating contracting collaboration with medical staff, health plans, and with legal council for effective and efficient implementation in executing contracts. Learn about successful tools, strategies, and case studies for negotiating terms and identifying opportunities in health plan agreements and physician contracts.

On Demand Webinar | Advanced | Financial Leadership

Effective Management of Physician Subsidy Levels

This session will present an effective process for assessing physician financial performance from an operational strategic standpoint. The speakers will share a defined process to manage physician financial performance, including how to use cost accounting concepts to establish and manage appropriate operating budget results as well as how to use ROI concepts to assess and monitor strategic benefits in comparison to subsidy loss levels.

Original Live Date: HFMA Digital Annual Conference (6/26/2020)

On Demand Webinar | Overview | Coronavirus

15 New CMS cash opportunities for providers

CMS is issuing more billing and payment updates at a faster pace than providers have ever experienced.  This "quick update" session will outline 15 new revenue producing services and/or specific codes to be charged and billed for additional reimbursement.

Original Live Webinar Date: 5/29/20

Course | Overview | Managed Care

Overview of Managed Care

This course provides an overview of the state of managed care today and discusses how and why it has evolved. It also identifies major initiatives that are currently affecting managed care and will continue to do so in the future, as the U.S. continues to implement the reforms associated with the passage of the Patient Protection and Accountable Care Act (ACA) in March 2010. The course offers a solid foundation of knowledge that will provide necessary context for the more detailed information presented in subsequent courses in this series.

Estimated course completion time: 45 minutes