2007 Salary Survey

CM salaries are increasing, but so are the hours

More paperwork and assignments present challenges

Salaries for case management are increasing, but the vast majority of case managers are working far more than the traditional 40-hour week, according to the results of the 2007 Case Management Advisor Salary Survey.

The 2007 Salary Survey was mailed to readers of Case Management Advisor in the June 2007 issue. Almost half of the respondents (42%) were in case management supervisory jobs and 25% were case managers. The rest were company presidents, vice presidents, owners or held other positions.

Respondents to the survey report putting in long hours. The vast majority of respondents (91%) report working more than 40 hours a week, with more than 16% reporting working 51 hours or more.

Today's case managers are spending a lot of time doing assessments rather than addressing some of the problems of the people they are assessing, says Catherine M. Mullahy, RN, BS, CRRN, CCM, president of Mullahy and Associates.

"Nurses across the board, especially in disease management and case management, feel that they spend more time documenting and filling out forms, rather than doing the things they feel will make a difference, leading to an increase in job dissatisfaction," she says.

At one time, nurses were attracted to case management because it was a Monday through Friday job with no holiday or weekend work. Now a lot of organizations have expanded the hours they want covered. For instance, there are nurse triage lines that operate 24 hours a day and disease management nurses who call on people in the evenings, Mullahy says.

As payers are requiring evening and weekend discharges, hospital case management departments try to keep weekend work to a minimum by recruiting specific nurses for weekend and evening shifts, adds Steven L. Robinson, director of KPMG LLP's health care advisory services. For instance, New York Hospital Queens has a social worker on staff who works only weekends. The staff of 23 case managers rotate weekend duty, according to Caroline Keane, director of case manager and social work. Case managers and social workers who work until 8 p.m. on weekdays receive an evening differential.

Case managers tend to be among the most experienced of nurses, with 92% of respondents working in health care for more 25 years or more. More than 91% of case managers responding to the survey reported getting a raise last year. The highest percentage of respondents (67%) reported getting a 1% to 3% raise, followed by 25% whose salary increases were between 4% and 6%.

Well more than half (65%) of respondents to the survey report salaries of $70,000 or more with 25% reporting salaries of more than $100,000.

Salaries for case managers tend to vary widely, depending on the practice setting, points out B.K. Kizziar, RN-BC, CCM, CLP, owner of B.K. & Associates, a Southlake, TX, case management consulting firm.

"Hospital case managers seem to be the lowest on the pay scale, with case managers who practice in managed care settings near the top. Commercial payers have always led the way for case managers. They have appreciated the value that case managers can bring to the table," she says.

Compensation for independent cases managers often varies depending on the job and the setting. "Salaries for independent case managers can run the gamut because they are as busy as they want to be," she adds.

On the other hand, there tends to be a wide range of differences in pay between nurses and social workers in any organization, Kizziar says. Many social workers have master's degrees but they are paid less than nurses who may not have a post-graduate degree, she adds.

The size of case management departments appears to have remained fairly constant over the past year. A third of respondents reported that their department had increases, with only 8% reporting a decrease in staff and 58% reporting no change.

However, the nursing shortage has impacted almost every aspect of nurse staffing, and case management is no exception, Robinson says. "From our observation, case managers are highly skilled professionals with a clinical nursing and management background. Those skills are difficult to attract," he adds.

Hiring qualified case managers continues to be a problem that is attributable to the nursing shortage but goes even further, Mullahy points out. "Even if we did have young men and women interested in going into nursing, the academic settings are having difficulty filling faculty positions. We don't have qualified people to teach. And, too, academic settings don't pay as well and nurses still have to feed their families and pay their mortgages," she says.

As a result, some nurses who become case managers don't have sufficient experience or training and may be unprepared for the job.

In large organizations, the person who hires the case managers may be a vice president of human resources and feel "a nurse is a nurse is a nurse and may not realize the additional experience and skills that are needed," Mullahy says.

"They have a couple of days' orientation and then they have a caseload. New case managers need to partner with more experienced ones so they don't get overwhelmed," she says.

Along with the gloom, there are opportunities for case managers, says Harry Leider, MD, MBA, chief medical officer for XLHealth.

"The growing burden of chronic illness in the Medicare population and our nation's need to address cost and quality presents wonderful opportunities for case managers. There are many exciting roles for case managers in health plans and disease management organizations including: telephonic health coaching, face-to-face patient evaluations and education, coordination of complex cases, and more traditional utilization management roles," Leider says.

For instance, Care Improvement Plus, a subsidiary of XLHealth, provides care coordination for seniors with chronic illnesses through its "Special Needs" Medicare Advantage plan. Every member in the program receives telephonic disease management from a health coach who is a registered nurse and face-to-face meetings with a nurse case manager. The program has grown from a pilot with 300 members in 2006 to providing care for more than 60,000 Medicare enrollees in six states.