I felt from very early in my nursing care that the most important role a nurse has is to be an advocate for the patient and that there were multiple forces pressing against the patient's best interest, especially in the form of overutilization. Case management was therefore a natural choice for me. The biggest con for me is that those same forces push against the case manager who is "too" aggressive about over utilization.
Handling a heavy case load is just triage. Some things just don't get done but make sure that they aren't thing that HAVE to be.