Green Card Utilization Management Specialist Jobs
Utilization Management Specialist roles qualify for EB-2 and EB-3 green card sponsorship through the PERM labor certification process, which lets U.S. healthcare employers permanently hire foreign professionals. Insurers, hospital systems, and managed care organizations regularly file I-140 petitions for candidates with clinical review and utilization review credentials.
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Get Access To All JobsINTRODUCTION
The Manager of Utilization Management provides daily oversight for Case Management teams (which includes RN’s, Social Workers, and Coordinators). The Manager of Utilization Management is responsible for ensuring high quality, cost-effective, and appropriate allocation of member services, treatments, and resources. The Manager of Utilization Management serves as a resource to Healthfirst’s care management team, members, and outside medical providers.
DUTIES/RESPONSIBILITIES:
- Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, referrals, and other plan services
- Develops and monitors goals for staff; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; and ensures an atmosphere of open communication, teamwork, and ownership and empowerment to make informed decisions
- Collaborates with medical staff and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems
- Allocate, monitor, and control resources while delegating and monitoring workloads
- Develops and analyzes operational and analytical reports to monitor and track operational efficiency
- Properly documents utilization management activities and rationale for all decisions in electronic medical records systems
- Functions as a clinical resource for the multi-disciplinary care team on an ongoing basis in order to maximize the quality of patient care while achieving effective medical cost management
- Additional duties as assigned
MINIMUM QUALIFICATIONS:
- Associate’s degree
- RN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical license
- Work experience demonstrating verbal and written communication skills
- Experience working independently in a fast-paced environment that requires problem solving skills and handling multiple priorities simultaneously
- Experience with Microsoft Office Suite applications including Excel, Word, Power Point and Outlook
PREFERRED QUALIFICATIONS:
- RN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical license
- Master’s degree in a related discipline
- Demonstrated professionalism and leadership skills along with the ability to train, develop, direct, and support staff
- Experience in managed care, case management, identifying alternative care options, and discharge planning across a variety of treatment settings for high risk, complex populations
- Certified Case Manager
- Interqual, Milliman, and/or TruCare knowledge
- Knowledge of Centers for Medicare & Medicaid Services (CMS), New York State Department of Health (NYSDOH), or MLTCP regulations governing medical management in managed care
- Work experience in managed care or healthcare industry in utilization management including preauthorization of outpatient or inpatient services
- Knowledge of utilization management/quality management case philosophies and reporting requirements to NY state and federal agencies.
COMPLIANCE & REGULATORY RESPONSIBILITIES:
The Manager is responsible for ensuring regulatory compliance with CMS, DOH, internal, and other relevant rules.
HIRING RANGE:
- Greater New York City Area (NY, NJ, CT residents): $116,800 - $168,810
- All Other Locations (within approved locations): $99,700 - $148,325
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
INTRODUCTION
The Manager of Utilization Management provides daily oversight for Case Management teams (which includes RN’s, Social Workers, and Coordinators). The Manager of Utilization Management is responsible for ensuring high quality, cost-effective, and appropriate allocation of member services, treatments, and resources. The Manager of Utilization Management serves as a resource to Healthfirst’s care management team, members, and outside medical providers.
DUTIES/RESPONSIBILITIES:
- Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, referrals, and other plan services
- Develops and monitors goals for staff; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; and ensures an atmosphere of open communication, teamwork, and ownership and empowerment to make informed decisions
- Collaborates with medical staff and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems
- Allocate, monitor, and control resources while delegating and monitoring workloads
- Develops and analyzes operational and analytical reports to monitor and track operational efficiency
- Properly documents utilization management activities and rationale for all decisions in electronic medical records systems
- Functions as a clinical resource for the multi-disciplinary care team on an ongoing basis in order to maximize the quality of patient care while achieving effective medical cost management
- Additional duties as assigned
MINIMUM QUALIFICATIONS:
- Associate’s degree
- RN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical license
- Work experience demonstrating verbal and written communication skills
- Experience working independently in a fast-paced environment that requires problem solving skills and handling multiple priorities simultaneously
- Experience with Microsoft Office Suite applications including Excel, Word, Power Point and Outlook
PREFERRED QUALIFICATIONS:
- RN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical license
- Master’s degree in a related discipline
- Demonstrated professionalism and leadership skills along with the ability to train, develop, direct, and support staff
- Experience in managed care, case management, identifying alternative care options, and discharge planning across a variety of treatment settings for high risk, complex populations
- Certified Case Manager
- Interqual, Milliman, and/or TruCare knowledge
- Knowledge of Centers for Medicare & Medicaid Services (CMS), New York State Department of Health (NYSDOH), or MLTCP regulations governing medical management in managed care
- Work experience in managed care or healthcare industry in utilization management including preauthorization of outpatient or inpatient services
- Knowledge of utilization management/quality management case philosophies and reporting requirements to NY state and federal agencies.
COMPLIANCE & REGULATORY RESPONSIBILITIES:
The Manager is responsible for ensuring regulatory compliance with CMS, DOH, internal, and other relevant rules.
HIRING RANGE:
- Greater New York City Area (NY, NJ, CT residents): $116,800 - $168,810
- All Other Locations (within approved locations): $99,700 - $148,325
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.
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Get Access To All JobsTips for Finding Green Card Sponsorship as an Utilization Management Specialist
Document your clinical review credentials early
PERM requires your employer to demonstrate you meet the minimum requirements for the role. Gather your nursing license, clinical certifications like CPHM or CCM, and any utilization review training records before your employer begins the prevailing wage determination.
Target managed care organizations with PERM history
Health plans, Medicare Advantage organizations, and third-party administrators file PERM petitions far more often than small practices. Focus your search on employers with in-house HR teams or dedicated immigration counsel, who can sustain a multi-year green card process.
Search open positions through Migrate Mate
Migrate Mate filters Utilization Management Specialist roles by employers with active green card sponsorship history, so you're not guessing which healthcare organizations will actually file. Use it to identify PERM-ready employers before you apply.
Understand how EB-2 versus EB-3 affects your timeline
If your role requires only a bachelor's degree and licensure, expect an EB-3 filing. EB-2 applies when the position genuinely requires an advanced degree. Your priority date and country of birth determine your wait, not which tier you file under.
Confirm the prevailing wage matches your offer letter
Your employer files a prevailing wage determination with OFLC before submitting PERM. Use the OFLC Wage Search to verify that the wage level assigned to your specific SOC code and work location matches what you've been offered, so there are no surprises during recruitment.
Ask your employer about concurrent filing eligibility
If your priority date is already current when PERM is approved, your employer can file the I-140 and your I-485 adjustment of status concurrently. This collapses the timeline significantly, so ask whether your country of birth and category make you eligible before the I-140 is filed.
Green Card Utilization Management Specialist: Frequently Asked Questions
Do Utilization Management Specialist roles qualify for EB-2 or EB-3 green card sponsorship?
Both categories are possible depending on how the position is defined. EB-3 covers roles requiring a bachelor's degree plus licensure, which covers most utilization management jobs. EB-2 applies when the employer can demonstrate the role genuinely requires an advanced degree, such as an MSN or MHA. Your employer's attorney structures the job requirements during PERM to determine which category fits.
How does the PERM green card process differ from H-1B sponsorship for this role?
H-1B visa is a temporary nonimmigrant status with a two- or three-year term and a highly competitive annual lottery. PERM is a permanent labor certification that leads to lawful permanent residency, with no annual lottery at the EB-3 level. The tradeoff is timeline: PERM recruitment and DOL review can take six to twelve months before the I-140 is even filed, but the outcome is a green card, not a temporary status.
Which employers sponsor green cards for Utilization Management Specialists?
Managed care organizations, large hospital systems, Medicare Advantage health plans, and third-party utilization review firms are the most consistent PERM filers for this role. Employers with in-house immigration counsel or established relationships with immigration law firms are far more likely to sustain the multi-year process. Use Migrate Mate to search specifically for employers with active green card sponsorship history in healthcare and utilization management.
Can I switch employers while my green card petition is pending?
Once your I-140 is approved and your I-485 has been pending for 180 days or more, AC21 portability lets you change to a same or similar occupation without losing your priority date. Utilization management roles typically qualify as same or similar to other clinical review and care coordination positions, but your new employer must be willing to continue the sponsorship and USCIS must agree the roles are sufficiently similar.
What documents do I need to support my PERM application as a foreign-trained professional?
Your employer files PERM, but you need to supply supporting documentation for your qualifications. This includes foreign degree equivalency evaluations, nursing or clinical licensure in the sponsoring state, any specialty certifications relevant to the job description, and employment verification letters covering prior utilization review experience. If your degree is from outside the U.S., a credential evaluation from a NACES-member organization is standard for meeting DOL education requirements.