Migliaccio & Rathod LLP is investigating whether GuideWell and its WebTPA subsidiary may have failed to pay overtime to certain utilization management nurses whose day-to-day work consisted largely of reviewing authorization requests under standardized health-plan rules and criteria.
WebTPA is a third-party administrator that handles health-plan services for self-funded employers. Its utilization management nurses may review requests involving hospital admissions, precertification, continued stays, and other healthcare services for multiple employer-sponsored plans. The underlying research identifies current WebTPA postings describing Utilization Management RNs performing precertification, reviewing emergency, urgent, and elective admissions, and evaluating utilization of healthcare services for self-funded plans.
Migliaccio & Rathod is investigating whether nurses performing this work were paid a salary, classified as exempt from overtime, and required to work more than 40 hours per week without additional compensation.
Nurses May Have Been Required To:
- review requests for precertification or prior authorization;
- evaluate emergency, urgent, or elective hospital admissions;
- conduct continued-stay or length-of-stay reviews;
- apply established health-plan or utilization-management criteria;
- document reviews in electronic systems;
- communicate with healthcare providers about authorization requests;
- meet turnaround-time, productivity, or quality expectations; and
- escalate cases requiring additional clinical or physician review.
Because WebTPA administers benefits for self-funded health plans, nurses may have performed substantially similar utilization-management work across numerous employer health plans rather than for a single insurance product.
Why Overtime May Be Owed
Registered nurses working in utilization management are not automatically exempt from overtime simply because they hold an RN license or perform healthcare-related work.
The actual duties performed matter.
If a nurse’s primary responsibility was to compare medical information against established criteria, follow predetermined workflows, process a required number of cases, and refer difficult or nonqualifying cases to someone else for final determination, the position may raise questions about whether the nurse exercised the level of independent discretion necessary for an overtime exemption.
Potential Claims May Include:
- unpaid overtime under the Fair Labor Standards Act;
- improper classification as overtime-exempt;
- unpaid wages under applicable state laws;
- failure to accurately record hours worked; and
- liquidated or statutory damages.
Signs You May Be Affected:
- You worked for WebTPA, GuideWell, or a related company 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 job primarily involved applying established criteria or health-plan rules;
- you were expected to complete a particular number of reviews or meet strict turnaround times; or
- you completed chart review, documentation, emails, or other work outside scheduled hours without additional pay.
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.