Health care managers come from a large number of professions. In addition to the majority of managers who graduate from programs in health care administration, public administration or business administration there are many different kinds of health care management jobs. These include clinical managers, financial managers, information systems managers, and public relations and marketing managers. Individuals with undergraduate or graduate degrees in management generally enter the field after the completion of their training with the goal of obtaining a middle management or upper level management position in a health care organization. Managers in professions such as finance often have worked in another field, have developed their skills and can readily transfer these skills to the health care environment. Clinical managers, including nurses and physicians, may work as clinicians for a period of time before entering management.
Entry-level
As in any organization, there are different levels of management in health care. Entry-level management positions are generally referred to as line supervisors. These people supervise the day-to-day activities of a group of employees. Examples of this type of position are a chemistry lab supervisor in a hospital, a nursing supervisor in a nursing home, a food services supervisor in an assisted living facility and a case management supervisor in a managed care company. Many of these individuals are trained in a clinical or technical field such as x-ray technology, ultrasound or nursing and have come up through the ranks.
Manager
The next management level is department manager, or department head. These individuals are responsible for an entire department in a hospital, nursing home or other health care organization. An environmental services manager in a nursing home, a health information management (also known as medical records) department head in a hospital, and a project manager in a consulting firm are all at this management level. Many of these individuals have formal management training (a Bachelor's or Master's degree or other training program) and/or certification in their specific discipline other than management.
Director
The level above department manager is often called director, although some organizations refer to their managers as directors. Director usually implies the management of a broad function in the company such as director of public relations or director of staff development who is responsible for their specific area in multiple departments and often for the entire organization. Managers in these roles may have clinical experience for instance in rehabilitation services or technical experience in an area such as medical records, management training and specific training and certification in their area of expertise (i.e. certified oncology manager or registered record administrator).In health care systems with corporate structures like Community Health system and Hospital Corporation of America two national hospital chains, the title of director is often used for individuals with corporate or system-wide responsibility for a function such as the director of materials management who is in charge of this function for all of the hospitals and other facilities in the system. Another example of a corporate director is the director of managed care at a smaller hospital system in the New York area, Atlantic Health.
Physicians
Physicians assume management roles as well. These include the head of a clinical department in a hospital (medicine, surgery, obstetrics), the head of a clinical section in a large hospital (e.g. cardiology, urology) and various positions in hospitals that are administrative in nature, including medical director, chief medical officer, director of performance improvement, director of clinical effectiveness and medical director of a managed care organization. Many of these physician-executives obtain management degrees and attend management training courses prior to or after achieving these positions.
Executive-level
There are several designations for executive-level management in health care organizations. One title sequence uses administrator to signify the highest management level. In this scheme there are associate administrators and assistant administrators. In hospitals and nursing homes that use these titles, the administrator is the highest ranking executive responsible for the entire organization. Associate administrators and assistant administrators report to this individual and are responsible for multiple departments and/ or large functional areas. A common variation of this structure is president and chief executive officer, executive and senior vice presidents and vice presidents. For the most part, the roles and responsibilities of these individuals correspond to the first set of titles. Another set of titles designates executive director as the top person, and associate and assistant executive director for the top managers reporting to this individual. Those who hold these positions may have worked their way up through the management ranks and almost always have graduate degrees in health care management, business administration or a similar discipline.
Corporate management
In health systems, multi hospital organizations or hospitals operating other facilities such as nursing homes and ambulatory care centers and academic medical centers there is also a corporate management level. These executives have system responsibilities for the operations and specific functions (e.g. financial management) for the entire organization and usually have the title corporate director or vice president. There is also a corporate president or chief executive officer and a corporate chief financial officer. These companies may be regional, national or international and either for profit or not for profit. They may be comprised of one type of health care facility, such as a nursing home, or many types, such as hospitals, physician practices and insurance companies. Manor Care, a for profit chain, for example operates long term care facilities throughout the country. Kaiser Permanente is comprised of physician practices, affiliated hospitals and provides various insurance plans.
In an academic setting, deans and university vice presidents often have overall responsibilities for the hospitals and other health care facilities in the organization. The health care executives at the hospital or other health care facilities report to these individuals.
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