2008 Salary Survey Results

Salaries are up, but so is the workload

Case managers have more responsibility than ever

Case managers made more money last year than ever before, but they also worked longer hours, according to the results of the 2008 Case Management Advisor Salary Survey.

The 2008 Salary Survey was mailed to readers of Case Management Advisor in the June 2008 issue.

A little more than half of the respondents (53%) were case management supervisors or directors, and 35% were case managers. The rest held other positions.

Raises across the board

All of the respondents reported getting a salary increase in last year, with the majority (59%) reporting increases of 1% to 3%. More than half (65%) reported salaries of $70,000 or more, with 12% receiving $100,000 or more in annual pay.

More hours

At the same time, respondents to the survey report putting in long hours. The majority of respondents to the survey (69%) report working more than 40 hours a week, with more than 25% reporting working 51 hours or more.

Long hours and more responsibilites than ever before are prompting case managers in every setting, to look at other options, says Catherine M. Mullahy, RN, BS, CRRN, CCM, president and founder of Mullahy & Associates, a case management training and consulting company.

"Case managers are being asked to do more and more in every practice setting and they can't manage everything. Because they're getting burned out at their jobs, they're looking at jobs in the pharmaceutical industry, withthe media, and with software development companies. There are more opportunities for experienced nurses than ever before," Mullahy says.

Case managers once worked Monday through Friday from 9 a.m. to 5 p.m., Mullahy points out.

Round-the-clock' coverage

"Health care is 24 hours a day and the need for 'round-the-clock' coverage has extended to case managers, whether they're in a hospital setting, conducting health coaching on the telephone, or working on a health plan's 24-hour nurse triage line," she says.

At the same time that responsibilities are increasing, staffing in case management departments appear to be on the rise. Almost 71% of the respondents reported an increase in staff in their department or company this year. None reported a decrease.

In last year's Salary Survey, only a third of respondents reported an increase in staff, with 58% reporting no change and 8% reporting a decrease in staff.

Increasing case loads problematic

However, increasing caseloads continue to be problematic, Mullahy adds.

"Too many organizations are attempting to streamline operations and don't see that case management is a complex matter and that in order to get the best results, case managers need to have manageable caseloads," she says.

Patients who benefit from case management have complex clinical, financial, and psycho-social issues and need to be managed on an individual basis, which can be time-consuming, Mullahy points out.

This sometimes places case managers in an adversarial role and increases dissatisfaction with their jobs, she says.

"Nurses want to feel good about what they do. In many organizations, that may not be the case because the administration doesn't understand the role of case managers. No matter what the practice setting, case managers are faced with conflicts when it comes to trying to meet the needs of their employer and do the best thing for the patient," she adds.

Retaining CMs

In order to retain experienced case managers, organizations need to recognize the value that they bring to the table, Mullahy says.

At Hudson Health Plan in Tarrytown, NY, case managers are made to feel they're part of the team and that they can ask for assistance when they feel overwhelmed, says Margaret Leonard, MS, RN-B, C, FNP, senior vice president for clinical services.

The department has a daily "stand-up" meeting during which the staff members have an opportunity to talk about what they're working on that day and ask for or offer help as needed.

Managers must set priorities

"Managers have to be realistic. If you are down staff—someone is absent or you have a vacancy in your department—you can't expect reports to be done immediately. You can't ask people to do more with less. You have to set priorities," she says.

The case managers and the supporting staff are all cross-trained so they can pitch in and work on any problem or project, she adds.

Hudson has been able to recruit experienced case managers and to retain them over the years, Leonard says.

"We've been lucky. We have had little turnover, but when people retire, it's tough to fill their position," Leonard says.

Case managers at Hudson Health Plan are required to sit for case management certification within a certain period of time if they aren't already certified. The insurer pays for the certification review course and gives case managers a substantial increase in salary when they achieve certification, Leonard says.

Case managers tend to be among the most experienced of nurses. More than 93% of respondents to the Case Management Advisor survey have worked in health care for more than 16 years or longer, and 67% report working 25 or more years in the health care field.

More than half (53%) have 10 years or more experience in case management.

That experience and the skills that nurses develop at the bedside are necessary for them to be effective case managers, Leonard says.

For instance, telephonic case managers who have worked at the bedside have the experience to recognize when a client's breathing is labored and urge the client to see a doctor, she points out.

"Nothing compares with the frontline duty of being a bedside nurse to get experience. If you haven't been a nurse in a medical-surgical hospital, you can't understand the challenges of admitting a patient, getting data, finding time to complete the assessment, knowing medications, and everything involved in discharging patients or transferring them from one floor or setting to the other," she adds.

But nursing schools are turning out fewer nurses, not because of lack of interest in nursing as a career but because of a shortage of experienced faculty members, Mullahy points out.

"To teach in a university setting requires a master's degree. Nurses with advanced degrees are in high demand in the hospital setting and other fields, all of which pay more than nursing schools can," Mullahy says.

CMs aging

The aging of case managers is likely to make recruiting more difficult in the future, says Toni Cesta, RN, PhD, FAAN, vice president, patient flow optimization for the North Shore-Long Island Jewish Health System and health care consultant and partner in Case Management Concepts LLC.

"The pool of case managers is getting older without younger, experienced nurses coming along to take their place. This is going to be a bigger challenge than the nursing shortage in future years," she adds.

About 69% of respondents to the Case Management Advisor Salary Survey are over age 50, while 13% report being 61 years or older. Only about 6% report being age 40 or younger.

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