Migliaccio & Rathod LLP is investigating whether Evolent Health may have improperly classified certain utilization review and clinical review nurses as exempt from overtime pay despite requiring them to perform standardized, criteria-driven work.
Evolent Health employs nurses in remote utilization-management and clinical-review positions. Current and recent Evolent Health job materials describe Clinical Reviewer Nurses as members of the utilization-management team, while postings seek nurses with experience using clinical decision-making criteria such as Milliman/MCG and InterQual.
Current and former Evolent Health utilization review nurses have also described working under productivity requirements. A February 2026 employee review from a Utilization Review Nurse states that the position is remote but requires employees to meet productivity goals and periodic testing requirements.
Migliaccio & Rathod is investigating whether nurses who performed this type of work were paid a salary, classified as exempt, and denied overtime despite regularly working more than 40 hours per week.
Nurses May Have Been Required To:
- review hospital admissions, continued stays, procedures, or treatment requests;
- compare medical records against InterQual, MCG, Medicare, Medicaid, or other predetermined criteria;
- follow standardized utilization-management policies and workflows;
- process a required number of reviews or cases each day;
- satisfy productivity, timeliness, quality, or audit requirements;
- document decisions in electronic systems; and
- refer cases that did not satisfy established criteria to a physician, medical director, or another higher-level reviewer.
Publicly available information concerning Evolent Health utilization nurses describes work involving inpatient and outpatient reviews using standardized clinical criteria, along with productivity expectations.
Why Overtime May Be Owed
Being a registered nurse does not automatically mean an employee is exempt from overtime.
The actual job duties matter.
A nurse whose primary job consists of applying predetermined rules, guidelines, or computer-driven criteria to authorization requests may have less independent discretion than a nurse providing direct patient care or independently exercising clinical judgment.
This may be particularly important where a nurse cannot independently deny a request and instead must send cases that fail established criteria to a physician or medical director.
Migliaccio & Rathod is investigating whether Evolent Health nurses performing these duties should have received overtime compensation when they worked more than 40 hours in a workweek.
Potential Claims May Include:
- unpaid overtime under the Fair Labor Standards Act;
- improper classification as an overtime-exempt employee;
- unpaid wages under applicable state laws;
- failure to maintain accurate records of hours worked; and
- liquidated or other statutory damages.
Signs You May Be Affected:
- You worked for Evolent Health as a Utilization Review Nurse, Clinical Reviewer Nurse, Utilization Management Nurse, Prior Authorization Nurse, or similar nurse reviewer;
- you were paid a salary and told you were not eligible for overtime;
- you regularly worked more than 40 hours per week;
- you primarily applied InterQual, MCG, CMS, health-plan, or other predetermined criteria;
- you had productivity goals, case quotas, turnaround-time requirements, or quality scores; or
- cases that did not meet the criteria generally had to be escalated to a physician or medical director.
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.