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 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.
Course | Overview | 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....
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 | Advanced | Financial Leadership

Effective Management of Physician Subisdy 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 | Advanced | Payment Trends

Healthcare Finance: The Big Picture

Next to national defense, the healthcare industry in the United States is one of the largest sectors of the economy. Currently making up almost 20 percent of the nation's gross domestic product, health care in the U.S. will be a significant factor in the national economy for the foreseeable future.

Estimated course completion time: 1 hour and 30 minutes

Certification | Overview | Revenue Cycle

Certified Revenue Cycle Representative Recertification

The CRCR recertification program is recommended for active, eligible, HFMA CRCR certificants with an upcoming maintainance due date of October 1, 2020*. Not sure when your CRCR expiration date is? Sign in, click your profile image in the upper right corner, select My Development, and then click on the Certifications tab near the center of the page. You'll see your certifications along with their expiration date. 

HFMA requires that eligible CRCR certificants gain continuing competence in the revenue cycle arena by taking a short assessment every two years.  The program provides healthcare organizations with a means to ensure that their revenue cycle staff has the body of knowledge necessary to meet their demands. 

Click here to see the list of specific topics covered in this year's recertification course. 

Assessment information:
This online program includes the recertification course and a recertification assessment. The assessment has 50 multiple choice questions and you have 90 minutes to complete it in one sitting. The passing score is 70%. If you do not pass on the first attempt, there is a mandatory 30-day waiting period. Please keep this in mind, as the deadline to complete the recertification assessment (to maintain your certification) is October 1, 2020*.

*During this unprecedented time HFMA is committed to meeting the need of its certified individuals. HFMA is implementing a certification maintenance grace period to allow for additional time to meet the recertification requirement. The maintenance deadline will be extended from May 31, 2020 to October 1, 2020.