July 01, 2019

Registered Nurses May be Classified as Exempt. Are Utilization Review Nurses Exempt as Well?

Sharon M. Dostmann, Deputy General Counsel, The Cooper Health System

Introduction

Utilization Review (UR) Nurses review hospital patient medical records for medical necessity, level of care, and length of stay to assist in determining reimbursement and preparation of clinical and authorization appeals where necessary.  The courts that have analyzed whether this job is exempt from the overtime requirements of the Fair Labor Standards Act (FLSA) have generally found that the UR nurses do not meet the definitions required for an exemption.  The rationale, up until recently, has rested on the UR job descriptions that included minimum qualifications of a licensed practice nurse (LPN) or registered nurse (RN) license and three or so years’ experience.  

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