Who this is for: RNs and LPNs doing prior authorization or pre-certification review, often remote, often on salary.

What's going on: The job is classified exempt. The quota runs you past 40 hours.

What you can do: Look at what you actually decide, and what you send to a physician. That decides the exemption.

A salaried prior authorization nurse is exempt only if the job's primary duty requires advanced nursing judgment; a nurse who matches requests against criteria, can approve but not deny, and sends everything else to a physician has a strong argument for overtime, though the Second Circuit has gone the other way.

What the job is and how it's classified

Prior authorization nurses review requests from providers for tests, procedures, drugs, and admissions. You pull the clinical notes, find the matching criteria (InterQual, MCG, or the plan's own policy), and document whether the request fits.

• Who hires: health plans, managed-care companies, and utilization-management vendors. Many roles are fully remote.
• The quota: a set number of cases a day, plus turnaround targets. The quota is what pushes the week to 45, 50, or more hours.
• Classification: often exempt "learned professional." LPNs and LVNs doing the same work are generally not exempt (see below).

So is that lawful? It depends on the work, not the license.

The license gets you in the door. The duties decide.

The rule says registered nurses "generally meet the duties requirements for the learned professional exemption".¹ The same rule says LPNs "generally do not qualify." An RN paid hourly is not exempt at all. See are nurses exempt from overtime?

For a salaried RN, the question is the primary duty. Does the job require advanced nursing judgment, or does it mean checking boxes against someone else's criteria?

Approve-only authority and physician referral

• You can approve, not deny. If the request doesn't fit the criteria, it goes to a medical director.
• Gray areas go up. Unclear cases go to a physician, not to you.
• Templates and scripts. Your notes follow a set form.
• Productivity tracking. You're measured on cases per hour and turnaround time.

Those facts point toward non-exempt work: applying the employer's standards, not exercising professional judgment.

The hard case: Isett v. Aetna

Be honest about it. In Isett v. Aetna Life Insurance Co.,² an RN "appeals nurse consultant" reviewed coverage appeals. The nurses would "locate the relevant criteria in Aetna’s clinical guidelines and apply the criteria to the information in the file," and "Only medical directors are authorized to deny insurance coverage for medical reasons." The Second Circuit still held her exempt as a learned professional and affirmed judgment for Aetna.

That's close to the prior-auth job. Here is how it differs, and where it doesn't:

• Isett was one nurse's case, decided on her record. A different record can come out differently.
• The court treated reading clinical files against guidelines as nursing judgment. The fight in later cases is how much of the job is really that, versus clerical matching, intake, and data entry.
• Isett binds federal courts in New York, Connecticut, and Vermont. It is not binding precedent in other circuits.
• The Fifth Circuit went the other way. In Clark v. Centene Co. of Texas,³ nurse "Case Managers" (RNs, LPNs, and LVNs) who reviewed "medical authorization requests submitted by health care providers", with titles that included "Case Manager I (Pre-Certification Nurse)," were held not exempt under either the administrative or professional exemption, and the court affirmed.

No one can promise the outcome. The duties, and the proof of them, decide it.

Remote login data proves hours

Remote work leaves a trail: VPN logs, system logins, case timestamps, chat messages. Off-the-clock work counts if the employer knows or has reason to know: "Work not requested but suffered or permitted is work time",⁴ including work "at home".⁵ Management "cannot sit back and accept the benefits without compensating for them".⁶

If the employer didn't keep accurate records, workers can prove hours by reasonable estimate.⁷

Case results: utilization review nurses

We have sued health plans and vendors over salaried UR nurse jobs, including Snider v. Quantum Health and Barbee v. NaviHealth. See utilization review nurse overtime.

Siegel Law Group has recovered more than $100 million for workers in federal overtime cases, including a $38.7 million class and collective settlement in Pruess v. Presbyterian Health Plan,⁸ where the firm was lead counsel. Past results do not guarantee future outcomes.

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What to do

• Save the job posting and your job description.
• Write down what you can approve, what you must send to a physician, and your daily quota.
• Note your real start and stop times. Don't take company data you aren't allowed to keep.
• How far back a claim reaches: two years, three if willful.⁹

Questions we hear

Are prior authorization nurses exempt?

Sometimes. A salaried RN can be, if the primary duty requires advanced nursing judgment. Approve-only, criteria-matching jobs are the ones that get challenged.

I'm an LPN doing prior auth on salary. Am I exempt?

Generally no. The rule says LPNs generally don't qualify for the learned professional exemption.

Does working remotely change anything?

No, except that your login data may prove your hours better than an office badge ever did.

What about appeals and grievance nurses?

Same analysis. That's the job Isett held.

Can I be fired for asking about overtime?

Not legally. The FLSA bars retaliation.¹⁰

Keep reading

• Do nonprofits have to pay overtime?
• Are social workers exempt?
• Service and support coordinators
• Foster care and child welfare caseworkers
• Behavioral health case managers
• Are nurses exempt from overtime?
• Am I misclassified as exempt? The 10-question check
• The 2026 exempt salary threshold
• No tax on overtime for salaried workers
• The learned professional exemption
• Got a notice about an overtime lawsuit?
• What an overtime lawyer costs
• Day-rate overtime: paid by the day isn't a salary
• Signed an arbitration agreement?
• How much is my overtime claim worth?
• Case manager overtime lawsuits
• Salary vs. hourly: who gets overtime
• How FLSA collective actions work
• How far back a claim reaches

Free, confidential case review: (214) 790-4454.

We take overtime cases on contingency. We advance the costs of the case, and if we recover, those costs are repaid out of the recovery. If we do not recover, you owe us nothing — no attorney's fee and no costs.

Notes

1. 29 C.F.R. § 541.301(e)(2).
2. Isett v. Aetna Life Insurance Co., 947 F.3d 122 (2d Cir. 2020).
3. Clark v. Centene Co. of Texas, No. 15-50606 (5th Cir. July 22, 2016) (unpublished).
4. 29 C.F.R. § 785.11.
5. § 785.12.
6. § 785.13.
7. Anderson v. Mt. Clemens Pottery Co., 328 U.S. 680 (1946).
8. Pruess v. Presbyterian Health Plan (D.N.M.), final approval June 24, 2026.
9. 29 U.S.C. § 255(a).
10. 29 U.S.C. § 215(a)(3).
11. See also: DOL Fact Sheet #17N (nurses).