The good news: there are more opportunities than ever before for case managers. The bad news is that, faced with more responsibilities, many hospital case managers are working longer hours but not always getting compensated for it.
Every respondent to the 2015 Hospital Case Management Salary Survey reported working more than 40 hours a week and 38% said they put in 50 hours or more each week. Thirty percent of respondents reported they received no raise last year and half of respondents got a 1% to 3% raise. Just 18% got raises of 4% or more.
However, a recent survey of certified case managers who work in a variety of settings showed that salaries are increasing, says Patrice Sminkey, RN, chief executive officer for the Commission for Case Management Certification.
The median salary for certified case managers who responded to the Health2 Resources and CCMC Professional and Demographic Characteristics of CCMs September 2015 survey1 was $75,000 to $80,000 a year, compared to the 2013-2014 survey when the median salary range was $70,000 to $75,000, Sminkey says. CCMC’s certified case managers represent a variety of disciplines including nurses, social workers, pharmacists, and others.
Hospital Case Management readers are older and experienced case managers, with the majority of respondents (65%) reporting being over 50. More than three-quarters of respondents (76%) reported healthcare careers of 22 years or longer and a similar percentage (75%) have been case managers for 10 years or longer. They’re well educated, with 55% holding a graduate degree.
Although seasoned case managers are beginning to retire, young case managers are taking up the slack, Sminkey says. According to the Health2Resources and CCMC survey, 38% of respondents who have become case managers after 2012 are under age 45.
“Our case managers are getting younger and they’re becoming certified earlier in their career,” she says.
“Hospital leaders are beginning to realize the importance of case managers and social workers. However, although the hours have increased, many times the pay has not,” says Brian Pisarsky, RN, MHA, ACM, associate director at Berkeley Research Group, with headquarters in Emeryville, CA.
“Regrettably, I think many case managers are working longer hours for the same pay,” adds Catherine M. Mullahy, RN, BSN, CCRN, CCM, president and founder of Mullahy and Associates, a Huntington, NY, case management consulting firm.
“In some cases, their employer may be taking advantage of their concern for their patients and sense of responsibility for their safety and well-being,” Mullahy says.
Pisarsky points out that in many hospitals, case manager pay is on a par with the pay of nurses.
“The trend is for nurses to work 12-hour shifts for three days a week. But we’re finding that case managers, because of large caseloads and daily responsibilities, typically spend 10 hours a day in order to get their job done but they still work five days a week," he adds.
More and more departments are going to hourly pay rather than exempt/salaried payment for the case management staff, an arrangement that allows case managers to be paid for additional hours, says Beverly Cunningham, RN, MS, consultant and partner at Dallas-based Case Management Concepts.
Some hospitals have been proactive and have begun re-engineering their departments to respond to changes in healthcare that have increased responsibilities for case managers, says Toni Cesta, RN, PhD, FAAN, partner and consultant in New York-based Case Management Concepts. “They are starting to look at across-the-continuum solutions as well,” she says.
“When the departments are carefully assessed based on current best-practice staffing ratios, many find that they need to add staff, sometimes in large numbers, in order for the department to remain effective,” she says.
One solution is to hire case management associates or clerical staff to support the professional work. In addition, there are case management software applications that help make the workload more manageable, she adds.
“It’s difficult to recruit case managers and using case management extenders helps significantly,” Cunningham says. She advises case management directors to thoroughly evaluate what each member of their staff is doing and determine what tasks are clerical and which require a professional. “Case management directors should have the goal of their professional staff working at the top of their license.”
Opportunities for case managers are cropping up in new arenas, thanks to the emphasis on care coordination in the Affordable Care Act, other federal legislation, and regulations from the Centers for Medicare & Medicaid Services and commercial payers that all call for case management, Sminkey points out. “We see ever-growing opportunities for advancement and new career tracks in accountable care organizations, HMOs, physician offices, community-based medicine, and other areas,” she says.
The new opportunities, combined with the pressures of the job, may prompt hospital case managers to look at other options for employment, Mullahy says. “When nurses have the title of case manager but find themselves spending more time with utilization review and computer-related tasks, it takes them away from really working with those patients who need their expertise and caring hearts,” Mullahy says.
Mullahy points out that the case management standards of practice do not support all of the tasks now expected of hospital case managers. “Those tasks, such as utilization review, observation status, determining the allocation of dollars for bundled payments do nothing to impact or improve the outcomes, care, safety, and satisfaction of patients,” she says.
This often leads to turnover as case managers realize that there are other opportunities, she says.
Pisarsky worked with one hospital where several of the case management staff left to work for a managed care plan. “The managed care job was Monday through Friday, the pay was higher, and the benefits were better. But they also said they were leaving because the stress level would be lower,” he says.
There is definitely turnover at some hospitals, says Cunningham, who attributes it at least in part to staff who are not ready for the accountability and requirements of the contemporary case management model.
“It’s not your momma’s case management department anymore,” Cunningham says. “These days, case management staff need to have a sense of urgency and work not only efficiently, but effectively,” she adds.
What is your annual income from your primary healthcare position?
In the last year, how has your salary changed?
What is your highest degree?
What is your age?
How many hours a week do you work?
How long have you worked in case management?
REFERENCE
- Commission for Case Management Certification. CMCoordinates: Charting your professional path. http://ccmcertification.org/cmcoordinates.
The good news: there are more opportunities than ever before for case managers. The bad news is that, faced with more responsibilities, many hospital case managers are working longer hours but not always getting compensated for it.
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