Many insurance companies, particularly managed care organizations, employ folks whose job it is to conduct “utilization reviews.” Utilization review consists of reviewing medical authorization requests against pre-determined guidelines and “medical necessity” criteria to determine with requested benefit, procedure, treatment, equipment, etc. should be covered by insurance. Utilization reviews may be conducted on a prospective (prior authorization), concurrent, retrospective basis. Throughout the industry, utilization review nurses have varying job titles including Utilization Management Nurses, Medical Management Nurses, Nurse Reviewers, or Case Managers, but essentially do the same work.

Some employers in the insurance industry pay its utilization review nurses a salary only and do not pay overtime pay for the overtime hours their employees work. These companies have treated their utilization review nurses as “exempt” or ineligible for overtime. Our overtime attorneys do not believe that this is right and have challenged that practice and argued that these insurance companies are improperly denying their workers overtime pay by misclassifying them under the law.

If you are employed as a utilization review nurse primarily conducting utilization reviews for an insurance company (or for companies that work with insurance companies), but you are not paid any overtime pay for hours worked over 40 in a workweek, you may have a claim. Our firm has handled these overtime cases and can help determine if you may be entitled to additional pay.

If you have questions about this investigation or would like to discuss your potential claims, please contact (612) 256-3207 or via email at ehenning@nka.com.