H-1B Visa Physician Reviewer Jobs
Physician Reviewer roles sit at the intersection of clinical expertise and administrative decision-making, making them a strong fit for H-1B visa specialty occupation classification. Employers filing LCAs for these positions typically list them under healthcare management or utilization review SOC codes, and sponsorship is common at health plans, managed care organizations, and third-party review firms.
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Get Access To All JobsINTRODUCTION
Located in Largo in the heart of Prince George’s County, our state-of-the-art regional medical center (University of Maryland Capital Region Medical Center) will provide improved access to primary and ambulatory care services and serve as a tertiary care center for critically ill patients. In addition, our new space will allow us to expand our offerings as a community partner to help improve the health status of Prince George’s County residents.
Position Summary:
Under general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient’s need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers.
PRIMARY RESPONSIBILITIES:
- Performs timely and accurate utilization review for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer.
- Communicates with clinical care coordinators, physician advisor, medical team and payors as needed regarding reviews and pended/denied days and interventions.
- Supports concurrent appeals process through proactive identification of pended/denied days.
- Implements the concurrent appeals process with appropriate referrals and documentation.
- Ensures appropriate Level of Care and patient status for each patient (Observation, Extended Recovery, Administrative, Inpatient, Critical Care, Intermediate Care, and Med-Surg).
- Reviews tests, procedures and consultations for appropriate utilization of resources in a timely manner.
- Conducts HINN discussions/Observation Education.
- Collaborates with Clinical Care Coordinators concerning Avoidable Days Collection.
- Ensures Regulatory Compliance related to Utilization Management conditions of participation.
- Assures appropriate reimbursement and stewardship of organizational and patient resources.
- Pursues and reports opportunities to improve reimbursement.
- Collaborates with admitting specialists regarding authorization policies and procedures of third-party payers. Remains current on clinical practice and protocols impacting clinical reimbursement.
WORK EXPERIENCE
Education
Bachelors in Nursing required.
Licensure as a Registered Nurse in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required.
One year of experience in case management or utilization management with knowledge of payer mechanisms and utilization management is preferred.
Two years’ experience in acute care and four years clinical healthcare experience preferred.
Certified Professional Utilization Reviewer (CPUR) preferred.
Additional experience in home health, ambulatory care, and/or occupational health is preferred.
KNOWLEDGE, SKILLS AND ABILITIES
- Highly effective verbal and written skills are required.
- Strong communication skills, self-confidence and experience in working with physicians are required.
- Excellent analytical and team building skills, as well as the ability to prioritize and work independently are required.
- The ability to work collaboratively with other disciplines is required.
- Ability to work with Hospital/Utilization Management and related software programs is required.
- Knowledge of utilization management is preferred.
BENEFITS
All your information will be kept confidential according to EEO guidelines.
COMPENSATION:
-
Pay Range: $40.61-$60.96
-
Other Compensation (if applicable):
Review the 2024-2025 UMMS Benefits Guide.
INTRODUCTION
Located in Largo in the heart of Prince George’s County, our state-of-the-art regional medical center (University of Maryland Capital Region Medical Center) will provide improved access to primary and ambulatory care services and serve as a tertiary care center for critically ill patients. In addition, our new space will allow us to expand our offerings as a community partner to help improve the health status of Prince George’s County residents.
Position Summary:
Under general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient’s need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers.
PRIMARY RESPONSIBILITIES:
- Performs timely and accurate utilization review for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer.
- Communicates with clinical care coordinators, physician advisor, medical team and payors as needed regarding reviews and pended/denied days and interventions.
- Supports concurrent appeals process through proactive identification of pended/denied days.
- Implements the concurrent appeals process with appropriate referrals and documentation.
- Ensures appropriate Level of Care and patient status for each patient (Observation, Extended Recovery, Administrative, Inpatient, Critical Care, Intermediate Care, and Med-Surg).
- Reviews tests, procedures and consultations for appropriate utilization of resources in a timely manner.
- Conducts HINN discussions/Observation Education.
- Collaborates with Clinical Care Coordinators concerning Avoidable Days Collection.
- Ensures Regulatory Compliance related to Utilization Management conditions of participation.
- Assures appropriate reimbursement and stewardship of organizational and patient resources.
- Pursues and reports opportunities to improve reimbursement.
- Collaborates with admitting specialists regarding authorization policies and procedures of third-party payers. Remains current on clinical practice and protocols impacting clinical reimbursement.
WORK EXPERIENCE
Education
Bachelors in Nursing required.
Licensure as a Registered Nurse in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required.
One year of experience in case management or utilization management with knowledge of payer mechanisms and utilization management is preferred.
Two years’ experience in acute care and four years clinical healthcare experience preferred.
Certified Professional Utilization Reviewer (CPUR) preferred.
Additional experience in home health, ambulatory care, and/or occupational health is preferred.
KNOWLEDGE, SKILLS AND ABILITIES
- Highly effective verbal and written skills are required.
- Strong communication skills, self-confidence and experience in working with physicians are required.
- Excellent analytical and team building skills, as well as the ability to prioritize and work independently are required.
- The ability to work collaboratively with other disciplines is required.
- Ability to work with Hospital/Utilization Management and related software programs is required.
- Knowledge of utilization management is preferred.
BENEFITS
All your information will be kept confidential according to EEO guidelines.
COMPENSATION:
-
Pay Range: $40.61-$60.96
-
Other Compensation (if applicable):
Review the 2024-2025 UMMS Benefits Guide.
See all 53+ H-1B Visa Physician Reviewer Jobs
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Get Access To All JobsTips for Finding H-1B Visa Sponsorship in Physician Reviewer
Verify your SOC code before applying
Physician Reviewer positions are filed under varying SOC codes depending on the employer. Check O*NET to confirm whether your target role maps to a clinical or administrative occupation, since the code affects your prevailing wage tier and LCA filing.
Target managed care and utilization review employers
Health plans, pharmacy benefit managers, and third-party utilization review organizations file LCAs for Physician Reviewers far more consistently than hospital systems. Filtering your search to these employer categories reduces time spent on sponsors unlikely to file.
Confirm your medical license covers the work state
Many Physician Reviewer roles are remote, but your employer's LCA must list the actual work location. If you'll review cases for patients in multiple states, check whether your license covers those jurisdictions before the offer stage, not after.
Use Migrate Mate to find verified H-1B sponsors
Search Migrate Mate to identify employers with active LCA filing history for Physician Reviewer roles. DOL Labor Condition Application data shows which organizations have actually sponsored this position, not just which ones say they're open to it.
Request premium processing if your start date is firm
Physician Reviewer offers tied to a credentialing or contract start date leave little room for USCIS standard processing timelines. Ask your employer to file with premium processing so you get a decision within 15 business days, per USCIS guidelines.
Clarify board certification requirements before the LCA is filed
Some employers require active board certification as a condition of the H-1B petition, not just the offer letter. If your certification is pending renewal, confirm with your employer whether USCIS will flag it during adjudication before the LCA is submitted to DOL.
H-1B Visa Physician Reviewer: Frequently Asked Questions
Does a Physician Reviewer role qualify as an H-1B specialty occupation?
Yes, Physician Reviewer positions generally qualify because they require a medical degree and clinical judgment to evaluate treatment authorization requests. USCIS looks for a direct relationship between the degree and the duties. Since the role requires applying clinical knowledge to coverage decisions, it typically meets the specialty occupation standard, though the employer's job description must clearly reflect those requirements.
How do I find employers who actively sponsor H-1B visas for Physician Reviewer roles?
The most reliable method is reviewing DOL Labor Condition Application disclosure data, which shows which employers have actually filed for this position. Migrate Mate surfaces this data by employer and role so you can identify health plans, utilization management firms, and managed care organizations with a real history of sponsoring Physician Reviewers, rather than relying on job posting language alone.
Can I work remotely as a Physician Reviewer on an H-1B visa?
Remote work is permitted, but the LCA must reflect the actual location where you perform your duties. If you work from home, your home address becomes the worksite. Your employer must post the LCA notice at that location and ensure the listed prevailing wage matches the wage level for your home area, not the employer's headquarters. This distinction matters at the time of filing.
Does my medical specialty affect H-1B sponsorship for Physician Reviewer jobs?
It can. Some utilization review employers hire only physicians with specific board certifications relevant to the lines of business they review, such as internal medicine, orthopedics, or behavioral health. If your specialty doesn't match the employer's case mix, you may face a narrower pool of sponsors. Reviewing the SOC code and job duties on the LCA helps confirm whether your background aligns with what USCIS will evaluate.
What happens to my H-1B status if my Physician Reviewer role becomes fully remote after I'm approved?
A permanent shift to a new work location requires an amended H-1B petition with an updated LCA reflecting the new worksite. USCIS and DOL treat a change in work location as a material change to the petition. Your employer must file the amendment before you begin working from the new location to keep your status compliant. Short-term remote work within the same metropolitan statistical area may not require an amendment, but confirm with your employer's immigration counsel.