Migliaccio & Rathod LLP is investigating whether Blue Cross Blue Shield of Michigan and Blue Care Network may have failed to properly compensate certain utilization management and clinical review nurses who regularly worked more than 40 hours per week.
Blue Cross Blue Shield of Michigan operates a substantial utilization-management program that uses established medical policies, criteria, and review procedures when determining whether requested healthcare services satisfy plan requirements. Its 2026 quality materials describe a formal utilization-management structure that adopts criteria sets and guidelines intended to be applied uniformly across utilization decisions.
Migliaccio & Rathod is particularly interested in hearing from salaried utilization-management nurses who did not receive overtime compensation, as well as nurses who regularly completed review or documentation work outside their recorded working hours.
Nurses May Have Been Required To:
- review requests for prior authorization or medical services;
- compare medical records with established clinical criteria or medical policies;
- perform prospective, concurrent, or retrospective utilization reviews;
- document reviews in electronic systems;
- comply with strict timeliness, quality, or productivity requirements;
- communicate with providers regarding authorization requests;
- prepare cases for physician or medical-director review; and
- complete additional documentation or case work outside normal scheduled hours.
Blue Cross Blue Shield of Michigan’s utilization-management program expressly tracks approval and denial rates, timeliness of determinations, and the uniform application of criteria and medical policies.
Why Overtime May Be Owed
A registered-nurse license or professional-sounding job title does not automatically determine whether an employee is exempt from overtime.
Migliaccio & Rathod is investigating whether some utilization-management nurses primarily performed standardized, criteria-driven review work and whether those employees were nevertheless paid a salary and denied overtime compensation.
We are also interested in nurses who were paid hourly but were expected to perform required work without recording all of the time spent completing it.
Potential Claims May Include:
- unpaid overtime under the Fair Labor Standards Act;
- improper classification as overtime-exempt;
- off-the-clock work;
- unpaid wages under Michigan or other applicable state laws;
- failure to accurately record all hours worked; and
- liquidated or statutory damages.
Signs You May Be Affected:
- You worked for Blue Cross Blue Shield of Michigan or Blue Care Network as a Utilization Management Nurse, Utilization Review Nurse, Clinical Reviewer, Prior Authorization Nurse, or similar employee;
- you were paid a salary and did not receive overtime;
- you regularly worked more than 40 hours per week;
- your reviews were primarily based on established criteria, policies, or standardized workflows;
- you had productivity, timeliness, case-volume, or quality requirements; or
- you routinely performed chart review, documentation, email, or other required work outside your recorded hours.
If you have encountered these issues, we would like to hear from you. Please complete the contact form on this page, send us an email at [email protected], or give us a call.