The pay doesn't rival amount of pressure and work. Aside from Case Management week, which consists of a bag of candy and wearing silly outfits, there is very little appreciation. However, management, most managers in the clinic, I mean, are wonderful and supportive. I've never been turned away. They are understanding because many are/were recent CM. They continue to add responsibility to your job but refuse to add money to your check.
Management in the clinics is not the problem. I learned that people who haven't worked in case management for over an extended period of time, should not compare their decades-old experience to the demands of today.
Every excuse is made to justify lack of pay increase, but the moment you don't perform satisfactorily, you'll know immediately. There will always be gossip in the workplace, but when you have the support of your management team, you're ok. And you will have that!