A managed access system is for mobile wireless devices (MWDs) in a facility geographically within a wireless communications network of a communications carrier. The system may include at least one RF antenna arranged at the facility and including an RF launch structure, and an elongate electrical conductor having a proximal end extending through the RF launch structure and a distal end spaced apart from the RF launch structure to define an elongate RF coverage pattern. The system may further include radio equipment coupled to the at least one RF antenna, and a management access controller cooperating with the radio equipment to communicate with a given MWD in the elongate RF coverage pattern within the facility, block outside communications via the wireless communications network when the given MWD is an unauthorized MWD, and provide outside communications via the wireless communications network when the given MWD is an authorized MWD.