2005 Salary Survey Results
Salaries are up, but CMs are putting in long hours
Nursing shortage presents challenges, advantages
Salaries for case management are increasing, but the vast majority of case managers are working far more than the traditional 40-hour week and in many cases are being asked to be more than ever before, according to respondents to the 2005 Hospital Case Management Salary Survey.
The 2005 Salary Survey was mailed to readers of HCM in the June issue. More than half the respondents (57%) were case management directors. Other respondents were case managers, utilization managers, social workers, or had other titles.
The increase in salary is bolstered in some instances by the nursing shortage as hospitals raise nursing pay levels, and case management salaries along with them.
For instance, at St. Vincent’s Medical Center in Jacksonville, FL, the care managers are paid at the same level as a position comparable to an assistant nurse manager.
"We don’t have a problem filling care manager positions because of the pay levels. Over the years, because of the competitive nature of nursing salaries within our region, the case management pay has risen in keeping with the nursing rate," reportsJamie Zachary, LCSW, director of case management.
At St. Vincent’s Medical Center, the average merit increase for case managers was 3% last year, but a recent adjustment in nursing salaries equaled a 10% increase. Benefits have remained the same in recent years.
Respondents to the survey report putting in long hours. In fact, almost 95% report working more than 40 hours a week, with more than 25% working more than 50 hours a week, up from 18.5% in the 2004 survey.
At the same time, 89% of respondents reported an increase in salary during the past year, about the same as respondents to the 2004 survey. The highest percentage (48.3%) reported getting a 1% to 3% raise, followed by 29% whose salary increases were between 4% and 6%, and nearly 9% who received raises of 5% to 10%. Only 11% reported no increase or a decrease in salary.
About 68% of respondents to the survey report salaries in the $60,000 to $99,000 range, with nearly 9% reporting salaries in excess of $100,000 and 23.6% reporting pay of $60,000 or less.
At the same time that salaries have risen, requirements for case managers have increased, says Mindy Owen, RN, CRRN, CCM, principal of Phoenix HealthCare Associates LLC, a Coral Springs, FL-based consulting firm specializing in case management, disease management, and managed care development and education and chair of the Commission for Case Manager Certification.
Most hospital nurse case manager jobs require three to five years of clinical experience, familiarity with computers and software, some managed care or HMO experience, and excellent interpersonal skills, Owen says.
Among respondents to the HCM Salary Survey, nearly 58% have 25 years or more experience in health care, with 47% of respondents reporting that they have worked in case management for 10 years or more.
Case managers are being called on to work evenings and weekends, and the role of case managers has expanded in many hospitals to include utilization review, discharge planning, and denials management — roles that in the past may have been delegated to staff in other departments.
Care management staff at St. Vincent’s are in the hospital from 7 a.m. to 1 a.m., seven days a week.
Weekdays are filled by full-time salaried staff, with part-time staff working in evenings and on weekends.
"Prior to 2002 when we hired people specifically for weekends, the staff had to rotate, and it was hard on morale," Zachary says.
While the nursing shortage has presented increasing challenges to hospitals in recent years, the effects on case management departments have been limited, case management directors report.
In fact, the nursing shortage has brought more nurses to the case management arena as a career option as nurses are opting out of the clinical role and moving to other positions, Owen says.
"Nurses on the floor are expected to handle more and more responsibilities. Their frustration level has risen because they are stretched so thin they can’t do the job they want to do and feel they should be doing in a clinical setting," she says.
In a way, the nursing shortage has led to increased compensation for case managers as hospitals raise the level of nurses’ pay. In large medical centers, case managers usually rank at the assistant nurse manager level or higher, with a corresponding bump in salary, Owen says.
Some hospitals are supplementing or replacing regular merit raises for staff with some form of compensation that is based on setting and meeting measurable goals, says Steve Blau, LCSW-C, director of case management at Good Samaritan Hospital in Baltimore.
"The trend is to go toward an incentive arrangement vs. steep changes in the base pay. Instead of a traditional merit raise, more hospitals are looking at pay for performance and basing increases on meeting goals and objectives," he says.
Blau has created a five-point scale for his employees, setting goals that include opportunities for bonuses and raises. The majority of the goals are team-based goals with raises tied to the outcome.
The goals depend on the hospital unit and the duties of the staff. For instance, some are based on inappropriate admissions, denials, or lengths of stay. Several of Blau’s colleagues at other hospitals have told him of risk-sharing arrangements in which a case management director agrees to a lower base salary with an opportunity to get a bigger bonus at the end of the year.
"If a case management department brings in $600,000 of denied-day overturns, case management directors may be inclined to ask for a percentage," he says. This trends points up the importance of case managers tracking outcomes and being able to show that they are affecting the bottom line, Blau adds.
"The goal is to continuously show the value of case management. If you have a good system of data collection and can translate it to show how much the case managers saved the hospital by reducing length of stay, this puts you in a position of strength, rather than just saying the staff is really working hard," he says.
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