Utilization Management Specialist Green Card 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 JobsCareers With Purpose
Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Facility: Marsh Security Hlth Plan
Location: Marshfield, WI
Address: 1515 N St Joseph Ave, Marshfield, WI 54449, USA
Shift: Day
Job Schedule: Full time
Weekly Hours: 40.00
Salary Range: $24.00 - $38.50
Department Details
Join the Health Plan Utilization Management team and leverage your RN expertise to conduct medical necessity reviews to ensure members receive appropriate, high-quality care.
Core Hours: Monday through Friday, 8am to 5pm, No weekends or holidays
Job Summary
Conduct level of care medical necessity reviews within patient’s medical records. Performs utilization management (UM) activities in accordance with UM plan to assure compliance with accreditation/regulatory requirements. Completes/coordinates activities relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. Completes activities relating to determination of medical necessity, authorization, continued stay review including diagnosis and procedural coding for working diagnosis related group (DRG) assignments. Workflows may include patient chart review, and assisting with and managing of insurance coverage and denials, prior authorizations, scheduled procedures, same-day readmission reviews, as well as length of stay. Ensure validation of appropriate level of care for pre-admission surgical reviews prior to admission. Reviews include InterQual clinical decision support criteria to ensure both the appropriateness of medical services and effective cost control. Ability to determine appropriate action for referring cases that do not meet departmental standards and require additional secondary review and/or escalation as needed.
May also be actively involved in collaborating with members of the healthcare team to promote medically necessary resource utilization and achievement of fiscal outcomes when appropriate. Collaborates with physicians and other clinical professionals as needed to assist in documentation improvement practices for effective and appropriate services. Dynamic and tactful interpersonal skills, particularly in relating to physicians and other health care professionals. Educates members of the healthcare team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization.
Assists the department in monitoring the utilization of resources, risk management and quality of care for patients in accordance with guidelines and criteria. Assist in report preparation, correspondence, and maintenance of appropriate records. Ensure services comply with professional standards, national and local coverage determinations (NCD/LCD), centers for Medicare and Medicaid services (CMS), as well as state and federal regulatory requirements. Maintain working knowledge of payer standards for UM functions for authorization requirements.
May assist with additional special projects related to work, upcoming initiatives, new organizational goals and audits when delegated. Considered a resource to all team members and acts as a point of contact for guidance, training, and assisting with questions. Demonstrate flexibility and adaptability where scheduling may fluctuate due to communication needs within interdepartmental and clinical units are required.
Qualifications
Bachelor's degree in nursing preferred. Graduate from a nationally accredited nursing program required, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).
Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing. Obtains and subsequently maintains required department specific competencies and certifications.
Benefits
Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits.
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org.
Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0255263
Job Function: Care Coordination
Featured: No
Careers With Purpose
Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Facility: Marsh Security Hlth Plan
Location: Marshfield, WI
Address: 1515 N St Joseph Ave, Marshfield, WI 54449, USA
Shift: Day
Job Schedule: Full time
Weekly Hours: 40.00
Salary Range: $24.00 - $38.50
Department Details
Join the Health Plan Utilization Management team and leverage your RN expertise to conduct medical necessity reviews to ensure members receive appropriate, high-quality care.
Core Hours: Monday through Friday, 8am to 5pm, No weekends or holidays
Job Summary
Conduct level of care medical necessity reviews within patient’s medical records. Performs utilization management (UM) activities in accordance with UM plan to assure compliance with accreditation/regulatory requirements. Completes/coordinates activities relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. Completes activities relating to determination of medical necessity, authorization, continued stay review including diagnosis and procedural coding for working diagnosis related group (DRG) assignments. Workflows may include patient chart review, and assisting with and managing of insurance coverage and denials, prior authorizations, scheduled procedures, same-day readmission reviews, as well as length of stay. Ensure validation of appropriate level of care for pre-admission surgical reviews prior to admission. Reviews include InterQual clinical decision support criteria to ensure both the appropriateness of medical services and effective cost control. Ability to determine appropriate action for referring cases that do not meet departmental standards and require additional secondary review and/or escalation as needed.
May also be actively involved in collaborating with members of the healthcare team to promote medically necessary resource utilization and achievement of fiscal outcomes when appropriate. Collaborates with physicians and other clinical professionals as needed to assist in documentation improvement practices for effective and appropriate services. Dynamic and tactful interpersonal skills, particularly in relating to physicians and other health care professionals. Educates members of the healthcare team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization.
Assists the department in monitoring the utilization of resources, risk management and quality of care for patients in accordance with guidelines and criteria. Assist in report preparation, correspondence, and maintenance of appropriate records. Ensure services comply with professional standards, national and local coverage determinations (NCD/LCD), centers for Medicare and Medicaid services (CMS), as well as state and federal regulatory requirements. Maintain working knowledge of payer standards for UM functions for authorization requirements.
May assist with additional special projects related to work, upcoming initiatives, new organizational goals and audits when delegated. Considered a resource to all team members and acts as a point of contact for guidance, training, and assisting with questions. Demonstrate flexibility and adaptability where scheduling may fluctuate due to communication needs within interdepartmental and clinical units are required.
Qualifications
Bachelor's degree in nursing preferred. Graduate from a nationally accredited nursing program required, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).
Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing. Obtains and subsequently maintains required department specific competencies and certifications.
Benefits
Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits.
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org.
Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0255263
Job Function: Care Coordination
Featured: No
See all 6+ Utilization Management Specialist jobs
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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.
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.
Utilization Management Specialist jobs are hiring across the US. Find yours.
Find Utilization Management Specialist JobsUtilization Management Specialist Green Card Sponsorship: 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 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.
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