Migliaccio & Rathod LLP is investigating whether certain Humana Utilization Management Nurses may have been denied overtime compensation despite regularly working more than 40 hours per week performing health-plan review and authorization work.
Humana employs nurses nationwide to review medical services and benefit determinations. Current Humana job materials describe Utilization Management Nurses as reviewing proposed healthcare against established CMS coverage guidelines and other review criteria. Other current positions describe nurses interpreting criteria, policies, and procedures when making benefit-administration determinations.
Migliaccio & Rathod is interested in hearing from current and former Humana nurses to determine how these positions were classified, how many hours nurses actually worked, and how much independent authority they exercised in practice.
Nurses May Have Been Required To:
- review requests for medical services or benefits;
- compare requested care against CMS guidelines or other established criteria;
- review medical records and supporting documentation;
- make or assist with coverage and authorization determinations;
- communicate with healthcare providers and members;
- document reviews in Humana’s systems;
- meet case-volume, timeliness, or productivity expectations; and
- complete outstanding cases or documentation outside regular working hours.
Humana’s current postings confirm that established criteria and procedures remain a significant part of utilization-management nursing work, although some positions also expressly describe independent clinical judgment.
For that reason, this investigation is particularly interested in what nurses actually did day to day, rather than simply their job titles.
Why Overtime May Be Owed
A nurse’s professional title does not by itself answer whether that employee is entitled to overtime.
The actual duties, pay structure, and level of independent discretion can matter.
A nurse who spends most of the workday processing a large volume of reviews under established criteria and workflows may be situated differently from a nurse who independently exercises substantial clinical authority.
Migliaccio & Rathod is investigating whether any Humana nurses were classified as overtime-exempt even though the realities of their positions entitled them to overtime compensation.
Potential Claims May Include:
- unpaid overtime under the Fair Labor Standards Act;
- improper overtime-exempt classification;
- unpaid wages under applicable state laws;
- failure to accurately record working time; and
- liquidated or statutory damages.
Signs You May Be Affected:
- You worked for Humana 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;
- most of your work involved applying established criteria, policies, or procedures;
- your authority to approve or deny requests was limited by company rules or escalation procedures; or
- you regularly completed cases, documentation, or other work outside your scheduled hours.
If you worked more than 40 hours per week as a Humana utilization-management nurse without receiving overtime compensation, 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.