Marilyn Shuler spent 39 years at Montefiore Medical Center doing work most patients never see but absolutely depend on. As a utilization review nurse, she read charts, assessed medical necessity, and fought insurers to keep patient care covered. On May 28, she got a letter: her position would be eliminated in 45 days — a case of replacing a licensed professional with software. The alleged replacement? Software from a health data company called Datavant—a move Montefiore disputes but unions call a clear substitution. The bitter twist: Shuler and her colleagues had just endured a 41-day strike that was supposed to protect them from exactly this.
These Nurses Stood Between Patients and a Denied Claim
Utilization review is the clinically informed, contractually critical function that keeps coverage decisions from being made in a vacuum.
Utilization review sits at the intersection of clinical knowledge and insurance bureaucracy. UR nurses interpret complex documentation, catch gaps, and advocate for coverage on cases where an algorithm would see data points but miss context. Montefiore is reportedly automating that function—extracting chart data and routing it to payers without licensed nurses in the loop.
- 12 UR nurses eliminated across Moses, Einstein, and Weiler campuses
- Termination effective July 12, 2026—45 days’ notice from letters dated May 28
- Layoffs followed a 41-day strike that began January 12, 2026, producing a contract with AI safeguards
- NYSNA filed a class-action grievance alleging the contract was violated
- Montefiore describes the Datavant system as a “nonclinical program that helps facilitate the paperwork process,” per spokesperson Joe Solmonese
“AI should be a tool used in conjunction with the clinical expert, not to replace,” Shuler told nurse.org.
The contract language nurses won required management to consult the union if AI caused “diminishment” of jobs. Instead, nurses reportedly noticed their workflows shifting quietly before any consultation occurred. Jamie Brown, president of National Nurses United, argues the situation should concern “every practitioner and patient who cares about the future of healthcare,” according to MedPage Today. Unions built AI clauses into that contract the way people set screen-time limits on their phones—a good-faith gesture that apparently evaporated the moment the hospital really wanted to look at cost savings.
What Happens in the Bronx Won’t Stay in the Bronx
This dispute is shaping up as a test case that could define how healthcare AI gets deployed across the country.
Montefiore’s Solmonese says union claims are “inaccurate and misleading.” But nurse Ajita Mathew, with 36 years at Montefiore, says management told staff the system is “not actually AI”—without explaining how coverage decisions get made after the nurses leave, per Bronx Times reporting. That opacity is the real problem. Like a software update that installs at 3am and breaks everything by morning, this rollout happened before anyone could ask substantive questions.
Former NYSNA president Judy Sheridan-Gonzalez told MedPage Today that Montefiore is “denying that AI has anything to do with this, which we know is not true.”
This is reportedly among the first known cases in the U.S. where licensed nursing roles were explicitly eliminated and replaced with AI-driven workflows. How this grievance resolves—and whether patients in the Bronx begin seeing more coverage denials—will shape every hospital’s AI playbook going forward. Patient coverage decisions across the country may depend on it.
