H-1B Visa Utilization Management Nurse Jobs
Utilization Management Nurses review medical necessity, authorize care, and work directly with payers and providers, a role USCIS classifies as a specialty occupation requiring at least a bachelor's degree in nursing. H-1B sponsorship is common at health systems, managed care organizations, and insurance carriers with active LCA filing history.
See All Utilization Management Nurse JobsOverview
Showing 5 of 103+ Utilization Management Nurse jobs
Have you applied for this role?
Have you applied for this role?
Have you applied for this role?
Have you applied for this role?
Have you applied for this role?
See all 103+ Utilization Management Nurse jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new Utilization Management Nurse roles.
Get Access To All JobsJob Description Summary
Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to The Utilization Management Nurse (UMN) reports to the Manager of Case Management and Care Transitions. Under general guidance of the Nurse Case Manager Team Leader of the Service Line, the UM Nurse functions as a member of the clinical service line team facilitates optimal reimbursement through accurate certification of their assigned patients. This position conducts initial admission reviews and refers cases for secondary review when appropriate. This role ensures the adherence to regulatory requirements with Medicare, FFS Medicaid, and other government payers. The UM Nurse refers and consults with the multidisciplinary team to promote appropriate communication of the review results to hospital revenue professionals to ensure proper utilization of hospital resources for accurate reimbursement.
Entity
Medical University Hospital Authority (MUHA)
Worker Type
Employee
Worker Sub-Type
Regular
Cost Center
CC005339 SYS - Utilization Management
Pay Rate Type
Salary
Pay Grade
Health-28
Scheduled Weekly Hours
40
Work Shift
Job Description
Hours per week: 40
Scheduled Work Hours/Shift: Days
Fair Labor Standards Act Status: Salaried
Job Summary/Purpose: Conducts utilization reviews to determine if patients are receiving care appropriate to severity of illness or condition and intensity of services required. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with providers and other stakeholders as needed.
Minimum Training and Education: Bachelor's degree in Nursing from an accredited school of nursing and five years of nursing work experience to include two years utilization / case management experience in a hospital setting required. Prior leadership experience preferred. Evidence of committee involvement within a healthcare setting needed (either departmental or hospital-wide). Must possess excellent verbal and written communication skills. Familiarity with InterQual and/or MCG screening criteria desired.
Required Licensure, Certifications, Registrations: Licensure as a registered nurse by the state of South Carolina or compact state required.
Physical Requirements:
(C)ontinuous = 6-8 hours per shift; (F)requent = 2-6 hours per shift; (I)nfrequent = 0-2 hours per shift) Ability to perform job junctions while standing (C), while sitting (I), while walking (F). Ability to climb stairs (I); work indoors (C); work from elevated areas (I); work in confined/cramped spaces (I); perform job functions from kneeling positions (I); bend at the waist (F); twist at the waist (F); squat and perform job functions(I); perform ‘pinching’ operations (I); and fully use both hands/arms (C). Ability to perform repetitive motions with hands/wrists/elbows and shoulders (F), ability to fully use both legs (C), to reach in all directions, possess good finger dexterity (C), maintain tactile sensory functions (C) and maintain good olfactory sensory function (C). Ability to lift and carry up to 50 lbs, unassisted and lift/carry patients up to 350 lbs (+/-), assisted. Ability to lift objects from floor level to height of 36 inches, up to 50 lbs, unassisted. Ability to lower objects, to 50 lbs, from height of 36 inches, unassisted. Ability to push/pull objects up to 350 lbs (+/-), unassisted. Maintain 20/40 vision, corrected. (C), see and recognize objects close at hand (C) and objects at a distance (C). Ability to match or discriminate between colors (C), to determine distance/relationship between objects; depth perception. (C) and good peripheral vision capabilities (C). Ability to maintain hearing acuity, with correction (C), ability to hear and understand whispered conversations at a distance of three feet, must be ambidextrous. Ability to perform gross motor functions with frequent fine motor movements (C). Ability to be qualified physically (by medical personnel) for respirator use, initially and annually. Ability to deal effectively with stressful situations. Computer literacy, ability to work rotating shifts, provide extended leadership coverage as needed, ability to learn and use new processes, tools equipment as required.
If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees
Job Description Summary
Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to The Utilization Management Nurse (UMN) reports to the Manager of Case Management and Care Transitions. Under general guidance of the Nurse Case Manager Team Leader of the Service Line, the UM Nurse functions as a member of the clinical service line team facilitates optimal reimbursement through accurate certification of their assigned patients. This position conducts initial admission reviews and refers cases for secondary review when appropriate. This role ensures the adherence to regulatory requirements with Medicare, FFS Medicaid, and other government payers. The UM Nurse refers and consults with the multidisciplinary team to promote appropriate communication of the review results to hospital revenue professionals to ensure proper utilization of hospital resources for accurate reimbursement.
Entity
Medical University Hospital Authority (MUHA)
Worker Type
Employee
Worker Sub-Type
Regular
Cost Center
CC005339 SYS - Utilization Management
Pay Rate Type
Salary
Pay Grade
Health-28
Scheduled Weekly Hours
40
Work Shift
Job Description
Hours per week: 40
Scheduled Work Hours/Shift: Days
Fair Labor Standards Act Status: Salaried
Job Summary/Purpose: Conducts utilization reviews to determine if patients are receiving care appropriate to severity of illness or condition and intensity of services required. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with providers and other stakeholders as needed.
Minimum Training and Education: Bachelor's degree in Nursing from an accredited school of nursing and five years of nursing work experience to include two years utilization / case management experience in a hospital setting required. Prior leadership experience preferred. Evidence of committee involvement within a healthcare setting needed (either departmental or hospital-wide). Must possess excellent verbal and written communication skills. Familiarity with InterQual and/or MCG screening criteria desired.
Required Licensure, Certifications, Registrations: Licensure as a registered nurse by the state of South Carolina or compact state required.
Physical Requirements:
(C)ontinuous = 6-8 hours per shift; (F)requent = 2-6 hours per shift; (I)nfrequent = 0-2 hours per shift) Ability to perform job junctions while standing (C), while sitting (I), while walking (F). Ability to climb stairs (I); work indoors (C); work from elevated areas (I); work in confined/cramped spaces (I); perform job functions from kneeling positions (I); bend at the waist (F); twist at the waist (F); squat and perform job functions(I); perform ‘pinching’ operations (I); and fully use both hands/arms (C). Ability to perform repetitive motions with hands/wrists/elbows and shoulders (F), ability to fully use both legs (C), to reach in all directions, possess good finger dexterity (C), maintain tactile sensory functions (C) and maintain good olfactory sensory function (C). Ability to lift and carry up to 50 lbs, unassisted and lift/carry patients up to 350 lbs (+/-), assisted. Ability to lift objects from floor level to height of 36 inches, up to 50 lbs, unassisted. Ability to lower objects, to 50 lbs, from height of 36 inches, unassisted. Ability to push/pull objects up to 350 lbs (+/-), unassisted. Maintain 20/40 vision, corrected. (C), see and recognize objects close at hand (C) and objects at a distance (C). Ability to match or discriminate between colors (C), to determine distance/relationship between objects; depth perception. (C) and good peripheral vision capabilities (C). Ability to maintain hearing acuity, with correction (C), ability to hear and understand whispered conversations at a distance of three feet, must be ambidextrous. Ability to perform gross motor functions with frequent fine motor movements (C). Ability to be qualified physically (by medical personnel) for respirator use, initially and annually. Ability to deal effectively with stressful situations. Computer literacy, ability to work rotating shifts, provide extended leadership coverage as needed, ability to learn and use new processes, tools equipment as required.
If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees
See all 103+ Utilization Management Nurse jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new Utilization Management Nurse roles.
Get Access To All JobsTips for Finding H-1B Visa Sponsorship as an Utilization Management Nurse
Verify your NCLEX and licensure transfers
Your RN license must be valid in the state where the employer is headquartered or where you'll work remotely. Multi-state compact licenses don't automatically cover all positions, so confirm portability before your employer files the LCA.
Target managed care organizations over staffing agencies
Health plans, utilization review firms, and integrated delivery networks file LCAs directly for UM Nurse roles. Staffing agencies can sponsor H-1B visas, but the cap-subject lottery adds risk that a direct hire avoids.
Search LCA filings by SOC code for UM roles
Utilization Management Nurses typically file under SOC 29-1141 (Registered Nurses). Use Migrate Mate to filter employers with verified LCA history for that code, so you're targeting companies with a documented H-1B filing track record.
Clarify remote work arrangements before the LCA is filed
DOL requires a separate LCA for each worksite, including home offices used for remote UM work. If you'll review cases from home, confirm your employer will file a worksite-specific LCA listing your home address.
Check the OFLC Wage Search before negotiating your offer
UM Nurse roles span wage levels I through IV depending on supervisory duties and case complexity. Run your job title and location through the OFLC Wage Search to verify your offer meets the prevailing wage before your employer certifies the LCA.
Ask employers about cap-exempt filing pathways
Hospitals affiliated with nonprofit research institutions or universities may qualify as cap-exempt H-1B employers. A cap-exempt filing bypasses the lottery entirely, which matters most if you're mid-career and can't afford another registration cycle.
Utilization Management Nurse jobs are hiring across the US. Find yours.
Find Utilization Management Nurse JobsUtilization Management Nurse H-1B Visa: Frequently Asked Questions
Does a Utilization Management Nurse role qualify as an H-1B specialty occupation?
Yes. USCIS treats UM Nurse positions as specialty occupations because the role requires at least a Bachelor of Science in Nursing and an active RN license. The job's clinical judgment component, applying evidence-based criteria like InterQual or Milliman to authorize care, supports the degree requirement that specialty occupation status demands.
Which types of employers sponsor H-1B visas for Utilization Management Nurses?
Managed care organizations, commercial health insurers, third-party utilization review firms, and large integrated health systems are the most active sponsors for UM Nurse roles. You can browse employers with verified LCA filing history for registered nurse occupations on Migrate Mate, which filters by SOC code and location.
Can I work remotely as a Utilization Management Nurse on an H-1B visa?
Yes, but DOL requires your employer to file a Labor Condition Application that lists every worksite where you'll perform H-1B work, including a home office. If your remote arrangement changes after the LCA is certified, your employer may need to file an amended LCA. Confirm this with your employer before accepting a remote-first offer.
What happens to my H-1B status if I move from a clinical nursing role into utilization management?
A move from bedside nursing to a UM Nurse position typically requires an H-1B amendment because the SOC code, wage level, and job duties change. Your employer files an amended I-129 with a new LCA before or concurrent with the role change. You can continue working during the amendment if your employer files before your duties shift.
How do I identify whether a UM Nurse job listing is likely to offer H-1B sponsorship?
Look for postings from health plans, utilization review contractors, and hospital systems that have previously filed LCAs for nursing roles. Listings that specify clinical review platforms like InterQual or Milliman signal a structured role with defined specialty occupation duties, which makes H-1B sponsorship more straightforward. USCIS is more likely to approve petitions where the degree requirement is clearly tied to the job functions.
See which Utilization Management Nurse employers are hiring and sponsoring visas right now.
Search Utilization Management Nurse Jobs