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Background: Management in healthcare industry has evolved over the years. There is increasing need for healthcare managers to acquire new skill sets particularly those related to strategic planning and business management. Aims: We sought to determine managerial competencies perceived as importsnt for healthcare managers in a tertiary healthcare institution in Calabar, Nigeria. Methods: A structured questionnaire (modeled after the Health Leadership Alliance competency questionnaire) was selfadministered to 266 randomly selected managers comprising 5 strategic managers, 53 middle managers and 208 operational managers. Data were analyzed using SPSS version 20. Results: A total of 266 managers were included in this study with a M: F ratio of 1.3: 1. The findings of this study showed that operational, middle and strategic managers rated 27, 37 and 46 of the competencies as contributing significantly with a mean rating of ≥ 4. Important/essential competencies differed between the three tiers of management. Competencies related to financial/business management were not considered very important. The result from qualitative arm synchronized with the quantitative arm to some extent, and provided insight to the managers' perspective. Conclusions: The findings of this study highlights the incongrous paradigm between managerial level and perceived important management competencies and supports the belief that there is inadequate managerial capacity especially those related to financial/business management.