Migliaccio & Rathod LLP is investigating whether Centene Clinical Review Nurses and other utilization-management nurses may have performed unpaid work because of productivity requirements, case volumes, documentation requirements, or strict authorization deadlines.
Centene employs nurses across its health plans to review prior authorization requests and determine whether requested healthcare services satisfy medical-necessity requirements. A current August 24, 2026 posting for a remote Clinical Review Nurse – Prior Authorization describes nurses conducting medical-necessity reviews according to regulatory guidelines and criteria, documenting clinical information, and working with providers and authorization teams to ensure timely reviews. The posting specifically describes the position as operating in a “metric-driven environment.”
Importantly, Centene currently advertises these Clinical Review Nurse positions at an hourly rate of $27.02 to $48.55.
Migliaccio & Rathod is therefore investigating whether hourly nurses were able to complete all required work during their paid shifts or instead performed uncompensated work to keep up with Centene’s review requirements.
Nurses May Have Been Required To:
- review prior authorization requests for medical necessity;
- apply InterQual or other established clinical criteria;
- review inpatient stays, outpatient services, DME, home health, or other requested care;
- document clinical information in health-management systems;
- communicate with healthcare providers and authorization teams;
- meet case-volume, productivity, quality, or turnaround-time requirements;
- escalate certain authorization requests to Medical Directors; and
- finish documentation or outstanding reviews outside scheduled working hours.
Centene’s current materials expressly state that Clinical Review Nurses escalate prior-authorization requests to Medical Directors when appropriate, while nurses themselves conduct the initial review according to regulatory guidelines and criteria.
Why Off-the-Clock Work Matters
Hourly employees generally must be compensated for all time they are required or permitted to work.
That can include time spent before or after a scheduled shift logging into systems, reviewing cases, finishing required documentation, answering work communications, or completing outstanding authorization requests.
Even 15 or 30 minutes of uncompensated work each day can add up to significant unpaid wages over months or years.
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;
- failure to maintain accurate time records; and
- damages under applicable state wage laws.
Signs You May Be Affected:
- You worked for Centene or one of its health plans as a Clinical Review Nurse, Prior Authorization Nurse, Concurrent Review Nurse, Utilization Review Nurse, or similar employee;
- you were paid hourly;
- you regularly had difficulty completing your assigned reviews during scheduled hours;
- you worked before clocking in or after clocking out;
- you worked through unpaid meal periods to keep up with cases;
- you completed documentation, emails, or other required tasks without recording the time; or
- managers knew employees were working beyond their scheduled or recorded hours.
If you performed unpaid work while employed as a Centene clinical-review or utilization-management 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.