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Keeping up with information technology and honing your communication skills in general could get you the job of your dreams — or at least help you keep the job you have and perhaps get a promotion down the road. "Case managers getting paid the most today are the ones who are good at producing outcomes data and know how to use the data they retrieve," says Janice Schriefer, RN, MSN, MBA. Computer and statistical skills are highly valued at Schriefer's facility, Spectrum Health in Grand Rapids, MI. "Computer-savvy, outcomes-savvy case managers have a good future," she maintains. "They are the ones I see succeeding because of their ability to help the organization."
She says that in her experience, an ability to communicate with physicians is also highly valued. "The case manager who can go to a physician and say, 'How do you want this done?' and then get the job done is a very valuable member of the staff."
Those two skills — information technology and verbal communication — fit well together, because, as Schriefer says, "then the case manager is able not only to implement good care but also to measure it. That helps get patients cared for better."
She says the more vulnerable employees are the ones about which a hospital administration can say, "What are they doing? The physicians don't seem happy. We don't have any reports that they've made a difference."
Michigan, like other states, is having to tighten all its hospitals' budget belts because of the federal Balanced Budget Act, and Schriefer says her hospital is experiencing a lot of problems related to that. Rather than cutting the number of full-time employees at Spectrum, the administration decided to give everyone pay cuts instead. "Just imagine how that went over!" says Schriefer, who is clinical system improvement specialist there. "When you cut staff and employees leave the facility, they are no longer around to complain. But when you do it this way — keep people on, but cut salaries — there's a lot of talk." The facility scaled the pay cuts; some cuts were as low as 3%, but the executives, she says, took as much as a 15% cut in salary.
"Certain jobs," she says, "the IT [information technology] jobs, for example, didn't take any cuts whatsoever because there's such a shortage of people who can do that work. Physical therapy also didn't take cuts because recruiting for those jobs is difficult." But all the nurses, including all the hospital-based case managers, took it on the chin. "Overall, there's a lot of downward pressure on salaries," says Schriefer. "And a lot of hospitals in Detroit had to fire staff."
What if you are fired or downsized? What if your pay should be cut to an extent that you feel you have no choice but to leave? One place for a hospital-based case manager to get a better job may be the outpatient setting, says Schriefer. "Physician offices weren't hit as hard this year as hospitals, and some of them are hiring case managers. Physician offices used to pay lower than hospitals, but now they are paying more. The hours are better — they are not open in the evenings, weekends, or holidays."
Do physicians prefer 'care managers'?
Does calling yourself "care manager" make you sound more modern or more accomplished than "case manager"? In Schriefer's opinion, what a case manager calls herself or himself should not matter, but "some time back, the physicians here didn't like the term 'case manager,' so we changed our name to 'care facilitators.'" In ways other than nomenclature, too, Spectrum's care facilitators tailor their programs to the physicians. "The bottom line is, physicians write the orders for all the care," says Schriefer. "If they don't see you as part of their team — if they see you as an HMO-minded utilization review person — they don't want to have anything to do with you. But if they see you as someone who can help them facilitate care quickly — get the right care to the patient and be able to measure what has been done — they like that."
She says she thinks the term "care facilitator" is better from the patient's perspective, too. "If you say to a patient, 'I'm your case manager,' he or she may feel like a 'case' — no more important than a bunch of numbers. 'Care' has such a nicer ring." She says the problem with managed care is that the word "managed' comes before the word "care." "The nice thing about 'care management' is you put the word 'care' first."
However, not everyone shares this viewpoint. "I don't like the word 'care' as opposed to 'case' to describe what we do," says Carol Fodge, RN, MS, director of care management at Provena Saint Joseph Hospital in Elgin, IL, on the outskirts of Chicago. "'Care management' sounds more like what bedside nurses do, and we do something beyond that, and on a parallel avenue. To me, the term 'care manager' doesn't ring true. If I were going for a job, I would call myself a case manager."
A case manager at Fodge's facility earns $35,000 to $45,000 a year, she says. "We can't offer as much as they do in Chicago." She says her position as director of care management would pay between $47,000 and $70,000. "If I went into the city, 30 miles away, I could make $20,000 more — up to $90,000." She says her hospital is part of a seven-hospital corporation, and "we all make different salaries for the same job."
Fodge is interviewing for a new case manager now, and she says what she is looking for is a "true" case manager — "a person who can do utilization review, quality assurance, risk management, and discharge planning. The whole gamut." She says a person who fits that description is not easy to find now, according to headhunters who are looking for applicants for her. "Experience is probably the most important factor I look for in an applicant. That and certifications."
Certifications boost credibility
Schriefer says certifications not only help you get a job but also help in getting raises and promotions. Credentials help your employer know what skills you have and add a lot of value to you as an employee. "If I didn't value my credentials, I wouldn't go back to keep all of them up," she says. "Back when I was certified for critical care nursing, I studied my butt off for that test. I did well, but it wasn't easy. My skills as an ICU nurse improved a great deal." She says case management certifications are tough, too. They are not expensive, and they encourage you to keep up your skills. Fodge agrees and says certifications help your credibility.
A vice president of Fodge's facility, a physician, encouraged her to get certified by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) in Tampa, FL. That board administers the Certified in Quality Assurance and Utilization Review (CQAUR) credential. "A nurse certified in case management would more likely hire someone with the CCM credential," she says. "But, if you interview at an institution where a physician is the director of the program, he may prefer you to have your CQAUR. It depends on the person interviewing you and what he or she thinks is important." Fodge says her CQAUR credential has given her plenty of clout with Provena Saint Joseph's physicians. "A couple of physicians on our staff have it, and it gives someone like me an edge."
Fodge says ABQAURP's continuing education program is excellent. "They require you to go to one of their seminars every three years to recertify, and they present the latest in utilization review, quality, and Joint Commission rules and regulations. It's hard to keep up with those things now without help. If I were reapplying for my job, the fact that I keep up to date would be a big plus — that, and being master's-prepared." She went back and got her master's degree in health services administration. "I got that instead of a master's in nursing," she says. "Many case managers today are getting an MBA. A master's degree with a business background is what employers are looking for now."
She says employers are looking for an expert in the field. "They don't want to hire someone who has to learn while she is on the job. Things are moving too quickly."
For more information, contact:
Janice Schriefer, RN, MSN, MBA, clinical system improvement specialist, Spectrum Health, Grand Rapids, MI. Telephone: (616) 391-2974.
Carol Fodge, RN, MS, director, care management, Provena Saint Joseph Hospital, Elgin, IL. Telephone: (847) 695-3200, Ext. 5432.