Deciding to take a new job? Outpatient CM job w/more flexibility vs hospital CM

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Specializes in Ambulatory Case Management, Clinic, Psychiatry.

Looking for some outside thoughts/perspectives on potentially taking a new job.

My background is mostly in psych, also outpatient clinic and case management. My long term goals (as of now), are to get into UR and possibly CDI, on the medical side. I like the idea of working for a managed care organization and having the ability to one or 2 days remotely.

Currently I work in outpatient case management for medicaid patients as a manager and w/a 1/2 caseload. I work for a nonprofit. I am not getting the acute medical exposure I would like, and there are a lot of frustrations within the nonprofit world including turnover, under performing direct care staff, and unreasonable expectations from the state. I also received student loan repayment through a lottery; they state has paid off my student loans (approx $20k) with the expectation I stay there for 4 years. I have been there 1.5 so far. If I leave now, I can keep approx $6500 and will need to pay the rest back ( would need to borrow from my retirement, although I am in my 30s so that is not an acute concern).

The new job would be as a hospital case manager in a community hospital on a medical floor. I don't have an official offer yet, but the rate they quoted me is about $6k more a year than I make now. Caseload would be 14-15, mostly covering 1 floor but sometimes other and occasionally ED pager coverage. Mostly discharge planning but I would learn UR/interqual and get to do some of that occasionally. I liked the manager when I met w/her, and her manager who I met briefly.

Pros of taking the job:

-exposure to inpatient medical (without doing med/surg direct care, which is generally a requirement to get into UR)

-stepping stone to other career areas

- a change (I am burnt out my current job and honestly get bored easily)

-not having to manage other people

-higher overall salary and likely guaranteed raises ever year (which I dont have now, raises are q 3-5 years @ the nonprofit)

Cons of taking job:

-having to pay back the student loan (and go through the process of figuring how to do that as far as regulations for borrowing from retirement..)

-working 1 major winter holiday (now I don't have to work any holidays)

-losing 4 weeks vacation (I imagine I"ll only have 2, or approx 20-25 days including sick time; they haven't sent me benefits info yet)

- losing some autonomy as I will no longer be a manager (and closing the door during lunch and doing my PT exercises without having to deal with anyone most days-- I imagine I wont have this ability on floor, although they did say I would have an office)

- having a different kind of unfamiliar stress (families, hospital teams vs. just dealing with my staff and sometimes needy clients, which are a known entity)

- loss of flexibility (I can flex my hours now, come in 15min later just to avoid the commute, leave early some Fridays if I ask ahead of time, etc)

- estimated new commute looks 10 min worse (current commute is about 45-50min each way; both jobs are only about 20 miles away but everyone is commuting those ways)

-leaving my current team in a lurch since they are already short 1 nurse and our other manager has moved and is mostly working remotely and will probably find something else closer to home-- I know this shouldn't matter, but I feel guilty and am friendly w/my current manager (as in, was part of a shared friend group before she hired me)

Definitely more cons than pros, but the job seems new and exciting... Maybe I should just wait for something in managed care or workers comp UR (another area of interest) to come along? The 2 managed care organizations near me have a lot of recent negative reviews from former employees, including from nurses and UR folks; I have been looking for a while. I could also try to hold out another 2.5 years until I have done my time for the full loan repayment. I have never stayed at a FT job more than 3 years.

Thoughts? Thanks in advance; sorry for being so wordy

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Specializes in OB.

Based on what you've described, I would stick it out at your current job so you don't have to pay back your loans. I would never get myself in a situation where I needed to take a large chunk out of my retirement fund, and I'm in my mid-30s, for what it's worth. The increase in your salary at the new job would not really matter if you have to pay back so much to your current job. If it's only another 2.5 years, I would stick it out. There are always new and exciting jobs out there.

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Specializes in PICU.

I vote for staying with the current job. For me the primary reasons would be, schedule, vacation, holiday, student loan payment and flexibility. Even with the higher salary, you will not be ahead of where you are now.

Is there any possibility you could ask to be trained on something else to add to your responsibliities? In addition to your 14-15 caseload, you will be always cross-covering someone. You will be competing with others for vacation slots, and will likely get the holidays noone wants. What guarantee do you have that you will not be bored in 1.5 years and wanting a change again?

Why not take a look at your current workflow, is there anything you would like to change, any system that could use a re-vamp? What about a nursing conference? Is there something you could do at work and then present at a casemanagement conference, I am sure there is, there is always something.

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I also vote stay.

You essentially would not make the $6K extra for 2+ years anyway, since you would be paying back your loans. If you're also going to lose some vacation, lose flexibility, get roped into holidays, and be running all over with inpatients and a pager? Ugh. (I'd ask to see the office, too. There's a decent chance it is a windowless space that really stretches the definition of "office.")

I can't see the availability of care management positions decreasing in the very near future. And a penny paid off by someone else is a penny earned. ?

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Specializes in Ambulatory Case Management, Clinic, Psychiatry.
35 minutes ago, LibraSunCNM said:

Based on what you've described, I would stick it out at your current job so you don't have to pay back your loans. I would never get myself in a situation where I needed to take a large chunk out of my retirement fund, and I'm in my mid-30s, for what it's worth. The increase in your salary at the new job would not really matter if you have to pay back so much to your current job. If it's only another 2.5 years, I would stick it out. There are always new and exciting jobs out there.

Thanks for your honesty.

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Specializes in Ambulatory Case Management, Clinic, Psychiatry.
32 minutes ago, RNNPICU said:

I vote for staying with the current job. For me the primary reasons would be, schedule, vacation, holiday, student loan payment and flexibility. Even with the higher salary, you will not be ahead of where you are now.

Is there any possibility you could ask to be trained on something else to add to your responsibliities? In addition to your 14-15 caseload, you will be always cross-covering someone. You will be competing with others for vacation slots, and will likely get the holidays noone wants. What guarantee do you have that you will not be bored in 1.5 years and wanting a change again?

Why not take a look at your current workflow, is there anything you would like to change, any system that could use a re-vamp? What about a nursing conference? Is there something you could do at work and then present at a casemanagement conference, I am sure there is, there is always something.

Thanks for your input. I don't really feel like I have time to add anything to my current responsibilities, but I see what you're saying. There are a lot of things that could be revamped/changed about the program; I am feeling somewhat defeated about a lot of it. We (the program director, who is a social worker, and I -- it is a behavioral health population even though we do medical CM as well) are constantly changing things up. The staff (not as much the 2 nurses I supervise, but the outreach/community health workers) are pretty overwhelmed and frustrated by lots of change. Will think about it.

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Specializes in Ambulatory Case Management, Clinic, Psychiatry.

Also, I forgot to mention this, but the program is for medicaid members w/behavioral health issues. We do both medical and behavioral health CM, but the nonprofit is a human services agency and run primarily by social workers vs. nurses. I like a lot of things about the agency, especially the flexibility; but they tolerate a lot of performance issues that I don't think other places necessarily would; and nursing leadership is lacking (my manager is a social worker, not a nurse). I feel a bit pigeonholed in psych still about this, but I guess if I am able to get an inpatient medical CM job interview, that is a good sign.

Tried to add this to my original post but wasn't able to edit it.

The flexibility and hours are the main thing, along w/the loan repayment of course, keeping me there. There isn't really anywhere to grow nursing wise in the agency. I don't think I'd get the flexibility at most other places and therefore not sure what I will do next if I don't take the position. Nursing positions, compared to academic and the business/start up world, seem pretty lacking in flexibility (besides choosing btw days/eves/nights and 3 12s).

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Specializes in OB.
35 minutes ago, ivyleaf said:

Also, I forgot to mention this, but the program is for medicaid members w/behavioral health issues. We do both medical and behavioral health CM, but the nonprofit is a human services agency and run primarily by social workers vs. nurses. I like a lot of things about the agency, especially the flexibility; but they tolerate a lot of performance issues that I don't think other places necessarily would; and nursing leadership is lacking (my manager is a social worker, not a nurse). I feel a bit pigeonholed in psych still about this, but I guess if I am able to get an inpatient medical CM job interview, that is a good sign.

Tried to add this to my original post but wasn't able to edit it.

The flexibility and hours are the main thing, along w/the loan repayment of course, keeping me there. There isn't really anywhere to grow nursing wise in the agency. I don't think I'd get the flexibility at most other places and therefore not sure what I will do next if I don't take the position. Nursing positions, compared to academic and the business/start up world, seem pretty lacking in flexibility (besides choosing btw days/eves/nights and 3 12s).

I get what you're saying, and that's tough. The idea of 2.5 additional years in a workplace that's just OK, essentially, could be less than appealing. I do still agree, though, that if you can get that interview now for the new job, then you'll be able to find equally interesting other options down the road, after your loans are paid off.

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