Do Utilization Review Nurses Get Overtime?

Often, yes. A utilization review nurse who checks requests against InterQual, MCG or the plan's own criteria and sends the hard calls to a physician is usually doing the kind of rule-following work the overtime exemptions don't cover.

Your employer says you're exempt because you're an RN on a salary. That's not how the Fair Labor Standards Act works. Overtime — time and a half for every hour over 40 in a week — is the default, and the employer has to prove an exemption fits. Your license doesn't decide it. Your salary alone doesn't decide it. Your actual work does.

The three tests

An employer must pass all three. Fail one, and you are owed overtime.

1. Salary basis. You must be paid a fixed salary, or fee, that isn't cut for the quality or quantity of your work. The Department of Labor's Fact Sheet #17N is blunt: “Registered nurses who are paid on an hourly basis should receive overtime pay.” See salary vs. hourly.

2. Salary level. $684 a week, or $35,568 a year. The 2024 rule was vacated (E.D. Tex. Nov. 15, 2024), and the Department of Labor formally reinstated the 2019 figures effective May 15, 2026.

3. Duties. This is where UR exemptions fall apart.

• The learned professional exemption, 29 C.F.R. §§ 541.300–.301: the primary duty must require advanced knowledge, meaning work “predominantly intellectual in character” that includes “the consistent exercise of discretion and judgment, as distinguished from performance of routine mental, manual, mechanical or physical work.” 29 C.F.R. § 541.301(b). The advanced knowledge must be customarily acquired by a prolonged course of “specialized intellectual instruction.”
• The administrative exemption, 29 C.F.R. §§ 541.200–.203: the primary duty must be directly related to running the employer's business and include “the exercise of discretion and independent judgment with respect to matters of significance.” 29 C.F.R. § 541.200(a)(3).
• Nurses: Fact Sheet #17N says registered nurses “generally meet the duties requirements” of the professional exemption. Generally is not always. It also says LPNs and similar health care employees “generally do not qualify as exempt” and “are entitled to overtime pay.”

Why the professional exemption is a poor fit for UR work

The professional exemption is built around the practice of nursing: assessing a patient, making clinical calls, deciding care. UR is different. You don't see patients. You read a record, open a criteria set and decide whether the request matches. If it does, you approve. If it doesn't, you don't deny on your own; you send it to a physician reviewer who makes the call.

That takes skill. Skill is not the “consistent exercise of discretion and judgment” the regulation requires.

Why the administrative exemption fails too

For a health plan or a UR vendor, utilization review is the business. It's the service the company sells. That makes UR nurses production workers, not the people who run the company. The same analysis applies to case managers and prior authorization nurses.

And discretion and independent judgment “must be more than the use of skill in applying well-established techniques, procedures or specific standards described in manuals or other sources.” 29 C.F.R. § 541.202(e). A UR job is designed to limit discretion so every reviewer reaches the same answer.

What your day looks like

Usually points to non-exempt, meaning you are owed overtime

• Applying InterQual, MCG or plan medical-policy criteria to authorization requests
• Following a scripted review template or decision tree
• Documenting reviews to meet turnaround and audit standards
• Working a daily queue of prior auth, concurrent or retrospective reviews
• Requesting missing records and scheduling peer-to-peers
• Making referrals to case management or other programs
• Escalating anything that doesn't meet criteria to a medical director

Can point toward exempt

• Writing or setting the medical policy and criteria others apply
• Issuing final denials on your own authority, with no physician or medical director review
• Overriding the criteria based on your own clinical judgment, as a regular part of the job
• Supervising two or more full-time employees as your primary duty, under the executive exemption
• Hands-on patient assessment and care planning as your primary duty

If your week lives in the first list, your exemption is in trouble.

The title doesn't matter

Utilization Review Nurse, Utilization Management Nurse, Prior Authorization Nurse, Concurrent Review Nurse, Pre-Certification Nurse, Clinical Reviewer, Medical Management Nurse, Utilization Manager. Different names, same job. If your primary duty is comparing clinical information against criteria someone else wrote, you are likely owed overtime. Doing case management too? Same rules — see case managers and care coordinators. More health plan cases are on our managed care page.

Our work for UR nurses

Pruess v. Presbyterian Health Plan, Inc., No. 1:19-cv-00629 (D.N.M.). 918 salaried Care Coordinators and Utilization Management Nurses. The court conditionally certified the collective, later certified a Rule 23 class and denied decertification, and granted final approval of a settlement on June 24, 2026. Siegel Law Group was lead counsel. Read about the settlement · Our New Mexico managed care cases · New Mexico wage law

Drake v. Tufts Associated Health Maintenance Organization, Inc., No. 1:19-cv-11876 (D. Mass.). The court conditionally certified a collective of salaried utilization review employees over the health plans' opposition. Settlement approved January 12, 2022. Read the ruling · Read about the settlement

Snider v. Quantum Health, Inc., No. 2:20-cv-02296 (S.D. Ohio). Utilization Review, Utilization Management, Pre-Certification and Rapid Response Nurses. The court conditionally certified an Ohio collective on February 1, 2021. The case settled. Read the ruling · Read about the settlement

Bellan v. Capital Blue Cross, No. 1:20-cv-00744 (M.D. Pa.). Salaried Medical Management Nurses, LPNs and RNs, doing utilization review. Conditionally certified October 26, 2020. The case settled. Read the ruling · Read about the settlement

Krott v. New Directions Behavioral Health, L.L.C., No. 4:19-cv-00915 (W.D. Mo.). Salaried Utilization Managers who, in the court's words, “review[] health insurance benefit requests against predetermined guidelines and criteria.” Conditionally certified September 10, 2020; settlement approved January 13, 2022. Read the ruling · Read about the settlement

Solis v. OrthoNet, LLC (S.D.N.Y.). Two cases in the Southern District of New York for workers who reviewed orthopedic and medical requests against medical-necessity criteria. The first covered 441 workers; the second settled the claims of more than 300 workers, and the court appointed Jack Siegel, among other counsel, as class counsel. Read about the settlements

Russell v. eQHealth Solutions, Inc., No. 3:19-cv-00005 (M.D. La.). Settled the claims of 63 workers who reviewed medical claims against medical-necessity criteria. Read the ruling · Read about the settlement

Kelly v. Evolent Health LLC, No. 1:19-cv-00500 (N.D. Ill.). Salaried care management employees, including Case Managers and Utilization Management Nurses. The collective was conditionally certified, and the case settled the claims of about 69 opt-ins. Siegel Law Group was lead counsel. Read the ruling · Read about the settlement

Menth v. Concerto Healthcare, Inc., No. 2:20-cv-11514 (E.D. Mich.). On October 2, 2020, the court entered a stipulated order conditionally certifying a collective of salaried workers who did utilization review. Read the ruling

Barbee v. NaviHealth, Inc., No. 3:19-cv-00119 (M.D. Tenn.). Settled the overtime claims of more than 1,100 salaried post-acute care management employees on an FLSA collective and Rule 23 basis. The court appointed Jack Siegel, among other counsel, as class counsel. Read about the settlement

A longer list of the companies is on our employers we've sued page.

Jack Siegel has filed overtime cases in 25 federal districts across 20 states, and has obtained 50+ class and collective certifications in 20 federal judicial districts across 15 states, as lead counsel on the firm's cases. The firm has recovered more than $100 million for workers, and it has never represented an employer in a wage case.

Prior results do not guarantee or predict a similar outcome in any future matter. These are results in other people's cases. Each case is decided on its own facts, its own record and its own procedural posture. Conditional certification and class certification are procedural rulings about whether a case may proceed as a group action; they are not findings of liability and they are not an award of money. This website contains attorney advertising.

What you can recover

If you were misclassified, the FLSA allows back pay for unpaid overtime, an equal amount again in liquidated damages, and attorney's fees and costs paid by the employer. Many states add their own overtime claims. What period a claim can reach back over is its own question of law, covered on our statute of limitations page, and group claims are explained on our collective and class actions page. In Texas? See Texas case managers and UR nurses. Your employer can't legally retaliate against you for raising it — see retaliation protections.

Questions UR nurses ask us

I'm an RN. Doesn't my license make me exempt?

No. The license is not the test. Fact Sheet #17N says RNs “generally” meet the professional duties test, but the exemption still depends on a salary basis and on what the job actually requires. Applying criteria and escalating to a physician is the fight we bring.

I work from home and log in early to clear my queue. Does that time count?

Yes. Time you are working counts, whether it's before your shift, after it, or on the weekend. If your employer knows or should know you're doing it, it counts. See off-the-clock work.

I'm an LPN doing UR. Am I exempt?

Probably not. Fact Sheet #17N says LPNs “generally do not qualify as exempt” under the professional exemption and “are entitled to overtime pay.”

I don't deny anything myself. I send it to the medical director. Does that matter?

It matters a lot. Sending the hard calls up to a physician is strong evidence you are applying criteria, not exercising the independent judgment an exemption requires.

Will this cost me anything?

You pay no fee and no costs unless we recover. We advance the costs of the case. If there is a recovery, those costs are repaid out of it.

Where to file a complaint with an agency

• FLSA overtime rules, U.S. DOL Wage and Hour Division
• File a complaint with the Wage and Hour Division
• DOL Fact Sheet #17N, nurses and the overtime exemptions
• Professional exemption and nurses, 29 C.F.R. § 541.301
• Administrative exemption regulations, 29 C.F.R. §§ 541.200–541.204

Sources

1. 29 U.S.C. § 207(a)(1) (overtime at one and one-half times the regular rate for hours over 40); 29 U.S.C. § 216(b) (liquidated damages, attorney's fees and costs); 29 U.S.C. § 215(a)(3) (retaliation).
2. 29 C.F.R. § 541.301(b) (advanced knowledge means work “predominantly intellectual in character” including “the consistent exercise of discretion and judgment, as distinguished from performance of routine mental, manual, mechanical or physical work”); 29 C.F.R. §§ 541.300–.301 (including advanced knowledge customarily acquired by a prolonged course of “specialized intellectual instruction”).
3. 29 C.F.R. § 541.301(e)(2) (registered nurses registered by the appropriate state examining board “generally meet the duties requirements for the learned professional exemption”; licensed practical nurses and other similar health care employees “generally do not qualify as exempt learned professionals”); 29 C.F.R. § 541.300(a)(1) (salary or fee basis).
4. U.S. Dep't of Labor, Wage & Hour Div., Fact Sheet #17N (“Registered nurses who are paid on an hourly basis should receive overtime pay”; LPNs and similar health care employees “generally do not qualify as exempt” and “are entitled to overtime pay”).
5. 29 C.F.R. § 541.200(a)(3) (administrative exemption; “the exercise of discretion and independent judgment with respect to matters of significance”); 29 C.F.R. § 541.202(e) (discretion and independent judgment “must be more than the use of skill in applying well-established techniques, procedures or specific standards described in manuals or other sources”).
6. 29 C.F.R. § 541.600(a) ($684 per week), as restored by 91 Fed. Reg. 27835 (May 15, 2026), after the 2024 salary-threshold rule was vacated in Texas v. U.S. Department of Labor (E.D. Tex. Nov. 15, 2024).
7. Pruess v. Presbyterian Health Plan, Inc., No. 1:19-cv-00629 (D.N.M.) (collective conditionally certified; Rule 23 class certified and decertification denied; final approval of settlement June 24, 2026).
8. Drake v. Tufts Associated Health Maintenance Org., Inc., No. 1:19-cv-11876 (D. Mass.) (conditional certification over the defendants' opposition; settlement approved January 12, 2022).
9. Snider v. Quantum Health, Inc., No. 2:20-cv-02296 (S.D. Ohio) (Ohio collective of salaried utilization review employees conditionally certified February 1, 2021).
10. Bellan v. Capital Blue Cross, No. 1:20-cv-00744 (M.D. Pa.) (collective of salaried Medical Management Nurses conditionally certified October 26, 2020).
11. Krott v. New Directions Behavioral Health, L.L.C., No. 4:19-cv-00915 (W.D. Mo.) (conditional certification September 10, 2020, describing Utilization Managers who “review[] health insurance benefit requests against predetermined guidelines and criteria”; settlement approved January 13, 2022).
12. Solis v. OrthoNet, LLC (S.D.N.Y.) (two cases; the first covering 441 workers, the second settling the claims of more than 300 workers).
13. Russell v. eQHealth Solutions, Inc., No. 3:19-cv-00005 (M.D. La.) (settlement of the claims of 63 workers).
14. Kelly v. Evolent Health LLC, No. 1:19-cv-00500 (N.D. Ill.) (collective conditionally certified; settlement of the claims of about 69 opt-ins).
15. Menth v. Concerto Healthcare, Inc., No. 2:20-cv-11514 (E.D. Mich.) (stipulated order conditionally certifying a collective, October 2, 2020).
16. Barbee v. NaviHealth, Inc., No. 3:19-cv-00119 (M.D. Tenn.) (FLSA collective and Rule 23 settlement for more than 1,100 employees).

You pay no fee and no costs unless we recover. Call or text (214) 790-4454, email [email protected], or contact us.

Attorney responsible: Jack L. Siegel, Dallas, Texas.