Healthcare organizations across the country should train their attention on a federal court case pending in Georgia that deals squarely with whether RNs performing utilization review (UR) work are exempt from overtime pay requirements. Depending on where your organization is located – and the specific work being done by the RNs in question – the answer is not always clear-cut. Indeed, it is a fact-sensitive inquiry that demands analysis of federal and state law, which do not always align. While still in its early stages, the Baker v. Anthem Companies case should remind healthcare employers to be thoughtful about how you classify and compensate your UR staff.
The ABCs of UR Work
Medical insurers, hospitals, and other healthcare providers regularly rely on utilization review (UR), or medical necessity reviews, as part of their core operations. The UR process ensures appropriate levels of care are provided to patients, in the right setting. It also helps ensure that medical resources are used appropriately. It is also critical work because it ensures that the care is covered and paid for by an insurer or other payors such as Medicare or Medicaid. Utilization reviews occur through the care continuum, typically governed by preset guidelines. In many instances, nurses perform these reviews.
A question that may not receive enough attention in your organization is whether your RNs performing these reviews are exempt from overtime pay requirements established by federal or local...
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