Migliaccio & Rathod LLP is investigating whether CareSource utilization review nurses and Clinical Care Reviewers may have performed uncompensated work because of case-volume, productivity, documentation, or medical-necessity review requirements.
Current CareSource materials describe Clinical Care Reviewer RNs as processing medical-necessity reviews for healthcare authorizations, including prospective, concurrent, and retrospective reviews of hospital admissions, outpatient procedures, home-care services, durable medical equipment, and other healthcare services. Nurses are also expected to involve a medical director when additional clinical expertise is required.
Recent utilization-review job materials indicate that at least some CareSource nurse-review positions are hourly rather than salaried. A 2026 posting for a remote Registered Nurse Utilization Reviewer expressly identified the compensation type as hourly.
Migliaccio & Rathod is therefore investigating whether nurses were required to perform significant work outside their recorded hours in order to keep up with CareSource’s workload and review expectations.
Nurses May Have Been Required To:
- review requests for medical necessity;
- conduct inpatient, outpatient, home-health, or DME authorization reviews;
- apply CareSource clinical guidelines and other standardized review criteria;
- document each review in electronic systems;
- communicate with providers and care-management personnel;
- involve medical directors where additional clinical review was needed;
- meet productivity or turnaround-time expectations; and
- complete unfinished work before or after scheduled shifts.
CareSource’s own utilization-management materials state that it uses clinical guidelines and accepted practices when determining medical necessity and appropriateness of requested services.
Public employee feedback also describes substantial workloads and demanding expectations among CareSource utilization-review teams.
Why Off-the-Clock Work Matters
An hourly employee is generally entitled to be paid for all compensable work the employer requires or permits.
That can include time spent:
- logging into multiple systems before a shift;
- reading work-related messages;
- finishing required documentation after scheduled hours;
- working through an unpaid meal period;
- completing mandatory reviews after clocking out; or
- performing other job duties from home outside recorded working time.
Where these practices occur repeatedly, nurses may be owed both unpaid wages and additional overtime compensation.
Potential Claims May Include:
- unpaid overtime under the Fair Labor Standards Act;
- off-the-clock work;
- unpaid straight-time wages;
- uncompensated meal-period work where applicable;
- inaccurate timekeeping; and
- damages available under applicable state wage laws.
Signs You May Be Affected:
- You worked for CareSource as a Clinical Care Reviewer, Utilization Review Nurse, Utilization Management Nurse, Prior Authorization Nurse, or similar employee;
- you were paid hourly;
- you regularly had difficulty completing required case volumes during scheduled hours;
- you began work before clocking in or continued after clocking out;
- you worked through unpaid meal periods;
- you performed required charting, documentation, emails, or Teams work without recording the time; or
- managers knew or should have known that employees were working beyond their recorded hours.
If you performed unpaid work while employed as a CareSource utilization review or clinical review nurse, 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.