On February 1, 2021, the U.S. District Court for the Southern District of Ohio conditionally certified a collective of salaried utilization review employees in Ohio in Snider v. Quantum Health, Inc., Case No. 2:20-cv-02296, granting the workers’ motion in part. In this Ohio utilization review nurse overtime lawsuit, the workers alleged that they were misclassified as exempt and not paid for hours over forty. Quantum Health did not oppose conditional certification itself; the disputes were over how far the collective reached and what the notice would say. Jack Siegel, with co-counsel, represented the workers.
Judge James L. Graham signed the Opinion and Order on February 1, 2021. The order described Quantum Health as a consumer healthcare navigation company. It administers health insurance programs for companies with self-funded employee benefit plans, and its Utilization Review Employees (“UREs”) decided whether to approve health insurance benefits.
The workers first asked for a collective of all non-supervisory, salaried, exempt-classified UREs from the last three years. Quantum asked the court to limit the group to its Ohio location. It noted that the workers’ two declarations described only that location. In reply, the workers agreed to limit the collective to Ohio.
In close paraphrase, the collective the court conditionally certified in 2021 included people who:
The court then ruled on the notice. Quantum had fourteen days to produce a computer-readable file of each collective member’s name, job title, dates of employment, mailing address, personal email address, telephone number, and work location. The court refused to order Social Security numbers for notices returned as undeliverable. It wrote: The Court finds that this request unnecessarily violates putative plaintiffs’ privacy.
The workers dropped their request for text message notice, so notice would go by mail and email. Quantum did not object to the proposed 63-day period to join. The parties had to meet and confer and file a joint proposed notice and consent form by February 15, 2021.
The part of the motion the court denied concerned the proposed notice and consent forms. The court adopted Quantum’s description of what the lawsuit was about. It agreed with Quantum that the notice must tell workers they could choose their own lawyer. It approved the workers’ language on why each person got the notice.
The workers alleged that some UREs may have been nurses by degree or registration, but their duties did not involve traditional nursing care in a clinical setting. They alleged that UREs did not exercise clinical judgment or provide direct care. Instead, the workers said, UREs applied and communicated Quantum’s practices, guidelines, and criteria for approving claims in an office or call center. The named plaintiff said he reviewed clinical information to decide whether it met set criteria for approving benefit requests.
The collective was not limited to four exact job titles. It also reached “other similar job titles” whose duties included utilization review work. That mattered because the named plaintiff said Quantum referred to his own position by several different names.
The notice rulings also protected workers. Quantum wanted the notice to warn that workers could owe court costs if the case was lost. The court refused, finding that such language could unfairly discourage people from joining. Instead, it ordered the notice to say that the named plaintiff’s lawyers had agreed to pay any costs that might be assessed in that case.
Conditional certification is a preliminary step. It is not a finding that anyone was misclassified or that Quantum Health broke the law.
The workers alleged that Quantum misclassified UREs as salaried employees exempt from state and federal overtime laws. They alleged that UREs regularly worked more than forty hours a week but were not paid for those overtime hours.
As general information, an employer that claims an exemption under the Fair Labor Standards Act (FLSA) has to prove it. A Department of Labor rule says registered nurses generally meet the duties test of the learned professional exemption (29 C.F.R. § 541.301(e)(2)). That exemption also requires pay on a salary basis, and the job’s main duty must actually require advanced knowledge. Whether a given review role qualifies depends on the work performed.
The administrative exemption also requires a salary of at least a set minimum. The main duty must be office or non-manual work directly related to the management or general business operations of the employer or its customers. That duty must also include the exercise of discretion and independent judgment on matters of significance.
The court applied, at the time of this 2021 order, the two-stage approach then used in its circuit. At the first stage, it used a “fairly lenient standard” that asked only for a modest factual showing that the workers were similarly situated. Some federal appeals courts have since changed this approach — the Fifth Circuit in Swales v. KLLM Transport Services (2021) and the Sixth Circuit in Clark v. A&L Homecare & Training Center (2023). Clark now governs federal courts in the Sixth Circuit.
This page describes a 2021 court order. The time to join that collective was set by the court in that case. If you have worked in a similar role, the Siegel Law Group can evaluate your own claims.
Have you worked as a Utilization Review Nurse, Utilization Management Nurse, Pre-Certification Nurse, or Rapid Response Nurse? Were you paid a salary, classified as exempt, and asked to apply set criteria to approve or deny benefit requests? A lawyer can review how you were paid. Contact the Siegel Law Group for a free consultation.
Related rulings: Bellan v. Capital BlueCross, another overtime case involving utilization review nurses, Drake v. Tufts, another 2021 case for salaried utilization review employees, and Krott v. New Directions, another case for salaried utilization managers.
The answer turns on the work itself. Under 29 C.F.R. § 541.301(e)(2), registered nurses generally satisfy the learned professional duties test. The employer must still show salary-basis pay and proof that the reviewer’s core work demands advanced, specialized learning. Each role is judged on the work performed; here, the workers alleged their duties did not involve clinical judgment or direct care.
The workers first sought all salaried, exempt-classified utilization review employees. Quantum Health asked the court to limit the group to its Ohio location because the workers’ two declarations described only that site. The workers agreed in their reply brief. The court then certified an Ohio collective covering the past three years, with four listed nurse titles and similar titles.
The workers asked the court to order Quantum Health to produce Social Security numbers for people whose notices came back undeliverable. The court refused, writing that the request unnecessarily violates putative plaintiffs’ privacy.
It relied on another court’s view that such a request intrudes on people who are, at that stage, just members of the public. Notice was to go by mail and email instead.
No. In this case, the court held that people who opt in have the right to choose their own lawyer. It ordered the notice to say that workers could be represented by the named plaintiff’s lawyers or by a lawyer of their own choosing. It also ordered the notice to say they could contact their own lawyer for more information.
In this case, the court refused Quantum’s request to warn workers that costs might be assessed against them. It found that such a warning could unfairly discourage people from joining. Instead, the notice had to say that costs may be assessed but the named plaintiff’s lawyers agreed to pay any such costs in that case. Rules in other cases can differ.
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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