The Presbyterian Health Plan overtime lawsuit produced a series of landmark rulings on behalf of approximately 700 care coordinators denied overtime pay while performing standardized care management work for one of New Mexico's largest managed care organizations. In Pruess v. Presbyterian Health Plan, Inc., Case No. 1:19-cv-00629-DHU-JFR (D.N.M.), the court granted FLSA conditional certification with equitable tolling, certified a Rule 23 class action under the New Mexico Minimum Wage Act (NMMWA), and denied the employer's motion to decertify the FLSA collective. The firm has recovered $100M+ for workers nationwide and concentrates in challenging overtime violations in the managed care industry.
This case produced four significant rulings across five years of litigation:
1. FLSA Conditional Certification (November 6, 2020): Judge Kenneth J. Gonzales granted conditional certification, allowing the case to proceed as an FLSA collective action on behalf of Care Coordination Employees (CCEs) at Presbyterian Health Plan and its subcontractor Fluent Health. The court found that despite 18 different job titles — including care coordinators, case managers, and utilization management nurses — all CCEs "had essentially the same primary duties": administering health plan benefits through non-clinical case management and utilization review.
2. Equitable Tolling (November 6, 2020): In the same ruling, Judge Gonzales granted equitable tolling of the FLSA statute of limitations — pausing the clock from November 19, 2019 until notice was issued. The court found that the approximately one-year delay while the court considered the certification motion was "undue and extraordinary," constituting half of the two-year FLSA limitations period. The court stated it would not "posture the viability of a plaintiff's cause of action on the Court's busy docket schedule."
3. Rule 23 Class Certification (August 16, 2024): Judge David Herrera Urias certified a Rule 23(b)(3) class of approximately 700 care coordinators under the NMMWA. The class encompassed all current and former Care Coordinators (Levels I through IV) employed by Presbyterian and Fluent Health in New Mexico from October 1, 2013 to the final date of judgment. The court appointed Attorney Jack Siegel as class counsel.
4. Denial of Decertification (August 16, 2024): In the same ruling, Judge Urias denied Presbyterian's motion to decertify the FLSA collective action. Applying the Thiessen three-factor test, the court found all three factors favored the workers. The court also granted the plaintiffs' request to subdivide the FLSA collective into a Care Coordinator Subclass and a Utilization Management Nurse Subclass for more efficient resolution.
The Pruess case represents one of the most comprehensive sets of rulings in any managed care overtime lawsuit in the country. The court's findings paint a detailed picture of how Presbyterian classified an entire workforce of care coordinators as exempt — and why that classification failed at every stage of litigation.
Judge Urias found that care coordinators across all four levels shared three core duties: (1) administering standardized Comprehensive Needs Assessment (CNA) questionnaires, (2) compiling auto-generated Care Plans, and (3) completing Touchpoints — phone calls and visits to check on members' compliance with their care plans. Workers testified they spent 80 to 95 percent of their time on these duties. Presbyterian "constantly tracked, captured, and monitored" CC work through auditing.
The court specifically rejected Presbyterian's use of "happy camper" declarations from three employees who said they preferred salary status, viewing them "with suspicion" given "Defendants' apparent interest in preserving its classification regime." The court also found that care coordinators are "front line staff" who "do not develop or create policies or develop operational practices" — they do not supervise employees, and they do not provide administrative services such as public relations, human resources, computer services, or marketing.
The equitable tolling ruling was equally important. In FLSA cases, the statute of limitations continues to run against potential plaintiffs while the court considers whether to certify the collective. By tolling the clock, Judge Gonzales ensured that workers' claims were not diminished by court processing delays — a ruling that reflects the remedial purpose of the FLSA.
Presbyterian Health Plan is one of New Mexico's largest managed care organizations, providing Medicaid managed care services under a contract with the New Mexico Human Services Department (HSD) through the Centennial Care program. Presbyterian subcontracted care coordination work to Fluent Health. Care coordinators at both entities administered standardized health assessments to Medicaid members, generated care plans, and conducted follow-up Touchpoints — all governed by HSD Contract requirements.
Presbyterian classified all care coordinators as exempt from overtime under the administrative exemption, paying them a salary with no overtime compensation despite workweeks that regularly exceeded 40 hours. The Siegel Law Group filed suit in 2019 and litigated the case through conditional certification, extensive discovery, class certification, denial of decertification, and ultimately resolution — a sustained effort that demonstrated the firm's commitment to holding even the largest managed care organizations accountable.
If you work as a care coordinator, case manager, or utilization review employee at a health plan, managed care organization, or behavioral health company, the Pruess rulings are directly relevant. Courts have repeatedly found that care management workers who follow standardized assessment tools, generate care plans within automated systems, and are subject to employer auditing and production tracking do not qualify for the administrative exemption — regardless of job title, licensure, or salary level.
The Rule 23 class certification means that all affected care coordinators were automatically included in the class unless they chose to opt out — a powerful mechanism that ensures no worker is left behind simply because they were unaware of their rights.
Having both gives workers maximum protection. The Rule 23 class (under the NMMWA) automatically includes all affected workers unless they opt out. The FLSA collective requires workers to affirmatively opt in. Together, they allow claims under both federal and state overtime laws, maximizing recovery for each worker.
Equitable tolling pauses the statute of limitations while the court considers whether to certify a collective action. Without it, workers' claims shrink every day the court takes to decide. In Pruess, the court tolled the limitations period for approximately one year — preserving claims that otherwise would have been lost to delays in the court's schedule.
Based on this case and consistent case law, care coordinators who follow standardized assessment protocols, use automated care planning systems, and are subject to employer auditing and production tracking are typically not exempt under the administrative exemption. The exemption requires the exercise of discretion and independent judgment on matters of significance — not following standardized protocols.
After conditional certification, employers can move to decertify the collective — asking the court to break up the group and force workers to sue individually. When a court denies decertification, as it did here, it means the collective survives and the case proceeds on behalf of all opt-in workers. This is a critical stage in any FLSA collective action.
Yes. Managed care organizations are subject to the same FLSA overtime requirements as any other employer. The Siegel Law Group has filed overtime lawsuits against health plans, managed care companies, and behavioral health organizations nationwide. Contact us for a free evaluation.
Courts have viewed such declarations with skepticism. In Pruess, Judge Urias specifically noted "Defendants' apparent interest in preserving its classification regime" and cited case law about employers making "misleading statements" to workers about what reclassification would mean. Your preference for salary does not determine whether the law entitles you to overtime.
The FLSA analysis applies nationwide. While the Rule 23 class was limited to New Mexico under the NMMWA, the conditional certification and denial of decertification rulings reflect federal law that applies in every state. Care coordinators at managed care organizations across the country may have claims.
The Siegel Law Group is a national overtime and wage law firm devoted entirely to representing workers denied overtime pay. Where many firms include wage cases as a small part of a broader employment practice, the Siegel Law Group has built its entire practice around overtime litigation — and the results reflect that commitment: $100M+ recovered for workers, 50+ class and collective action certifications, and 100+ federal lawsuits filed in 27+ federal courts nationwide. Founding attorney Jack Siegel is a Bloomberg BNA contributing author on wage and hour law.
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