Part of our utilization review cases →
Named plaintiff Scott Snider worked for Quantum Health in Ohio under titles including Rapid Response Nurse, Utilization Review Nurse, Pre-Certification Nurse and Utilization Management Nurse. He alleged that he reviewed clinical information to decide whether it met established criteria for approving insurance benefit requests, worked more than 40 hours a week, and was paid a salary with no overtime.1
Quantum Health did not oppose conditional certification of an Ohio collective. On February 1, 2021, Judge James L. Graham certified a collective of non-supervisory salaried Utilization Review Employees in Ohio and set the terms of notice.1 The case later settled.
The administrative exemption covers employees whose primary duty includes "the exercise of discretion and independent judgment with respect to matters of significance." 29 C.F.R. § 541.200(a)(3). Checking a request against criteria someone else wrote is not that. Whatever the job title, if the work is applying the insurer’s guidelines, the administrative exemption should not apply.
That Quantum Health classified its utilization review nurses as exempt even though they applied established criteria to benefit requests.
Often, yes. Nurses who apply an insurer’s criteria rather than exercising independent judgment may not meet the administrative exemption.
Under the FLSA, workers in the same job can join a collective action. Tell us your job title, employer and state, and we will review it.
If you did this kind of work for another employer and weren't paid overtime for hours over 40, tell us your job title, your employer and the state you worked in. We'll tell you plainly whether we think you have a case. Federal law makes it illegal to retaliate against you for asking.
Siegel Law Group PLLC concentrates in unpaid overtime cases under the FLSA and state wage laws. The firm has filed more than 100 federal overtime cases, obtained more than 50 class and collective certifications, and recovered more than $100 million for workers. Free consultation. Contingency fee: we advance case costs, and they are repaid from any recovery. No recovery, no fee and no costs. Phone: (214) 790-4454 | Email: [email protected]
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