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 visa sponsorship is common at health systems, managed care organizations, and insurance carriers with active LCA filing history.
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Get Access To All JobsINTRODUCTION
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
ROLE AND RESPONSIBILITIES
The Utilization Review Nurse, RN is responsible for providing clinically efficient and effective Inpatient utilization management. Reviews inpatient criteria for acute hospital admissions and concurrent review and or prior authorization requests for appropriate care and setting by following evidence based clinical guidelines, medical necessity criteria and health plan guidelines. Reviews and applies hierarchy of criteria to all inpatient admission and preauthorization requests from providers that require a medical necessity determination. Is involved in assuring that the patient receives high-quality cost-effective care. Uses sound clinical judgement and managed care principles in the coordination of care. Prepares any case that does not meet medical necessity guidelines for medical appropriateness of procedure, service or treatment for review with the Medical Director for a decision.
Required hours are 8am-5pm in PST or MST to include one weekend day, either Sunday-Thursday or Tuesday-Saturday, after the 3-6 month training period. Training for the first 3-6 months (or potentially longer depending on training progress) will be Monday-Friday 8am-5pm PST before moving to your regular schedule.
You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Maintains clinical expertise and knowledge of scientific progress in nursing and medical arena and incorporates this information into the clinical review and care coordination processes
- Performs clinical review for appropriate utilization of medical services by applying appropriate medical necessity criteria guidelines
- Authorizes healthcare services in compliance with contractual agreements, Health Plan guidelines and appropriate medical necessity criteria
- Documents clinical reviews in care management system. Provide accurate and timely documentation and supporting rational of decision in care management system
- Utilizes care management system and resources to track and analyze utilization, variances and trends, patient outcomes and quality indicators
- Research and prepares clinical information for case review with Physician Leadership for patient treatment and care planning
- Utilizes knowledge of resources available in the health care system to assist the physician and patient effectively
- Identifies members who are appropriate for care coordination programs and collaborates with the Medical Management team for care coordination of the member's needs along the continuum of care
- Successfully completes the Interrater Reliability Testing to ensure consistency of review and application of criteria
- Meets timeliness standards for decision, notification, and prior authorization activities
- Serves as an advocate for all providers and their patients
- Demonstrates a positive attitude and respect for self and others and responds in a courteous manner to all customers, internal and external
- Maintains the confidentiality of all company procedures, results, and information about patients, contracts, and all other proprietary information regarding Optum business
- Performs other duties as required or requested in a positive and helpful manner to enable the department to achieve its goals
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
BASIC QUALIFICATIONS
- Current unrestricted Registered Nurse (RN) license in state of residence (if residing in a multi-state/compact state, nurse must have the multi-state/compact license)
- 3+ years of clinical nursing experience in acute care hospital or LTAC setting
- 1+ years of Utilization Management experience in hospital or insurance setting
- Experience applying Medicare and/or Medicaid guidelines
- Experience with Milliman (MCG) or InterQual guidelines
- Experience researching and preparing clinical information for case review with Physician Leadership for patient treatment and care planning
- Experience providing accurate and timely documentation of clinical review and supporting rational of decision in care management systems
- Experience employing analytical skills necessary for quality case management, utilization review, and quality improvement to meet organizational objectives
- Experience using various computer software applications with an intermediate level of competence, including Microsoft Word and Excel
- Ability to work Monday-Friday 8am-5pm in Pacific Time Zone or Mountain Time Zone to include one weekend day, either Sunday-Thursday or Tuesday-Saturday, after the 3-6 month training period. Training for the first 3-6 months (or potentially longer depending on training progress) will be Monday-Friday 8am-5pm PST before moving to your regular schedule
PREFERRED QUALIFICATIONS
- Inpatient Utilization Management experience
- Utilization Management experience for insurance or managed care organization
- Prior Authorization experience
- Primary residence in Pacific Time Zone or Mountain Time Zone
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
COMPENSATION
- Salary Range: $60,200 to $107,400 annually based on full-time employment
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. We comply with all minimum wage laws as applicable.
APPLICATION DEADLINE
This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
INTRODUCTION
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
ROLE AND RESPONSIBILITIES
The Utilization Review Nurse, RN is responsible for providing clinically efficient and effective Inpatient utilization management. Reviews inpatient criteria for acute hospital admissions and concurrent review and or prior authorization requests for appropriate care and setting by following evidence based clinical guidelines, medical necessity criteria and health plan guidelines. Reviews and applies hierarchy of criteria to all inpatient admission and preauthorization requests from providers that require a medical necessity determination. Is involved in assuring that the patient receives high-quality cost-effective care. Uses sound clinical judgement and managed care principles in the coordination of care. Prepares any case that does not meet medical necessity guidelines for medical appropriateness of procedure, service or treatment for review with the Medical Director for a decision.
Required hours are 8am-5pm in PST or MST to include one weekend day, either Sunday-Thursday or Tuesday-Saturday, after the 3-6 month training period. Training for the first 3-6 months (or potentially longer depending on training progress) will be Monday-Friday 8am-5pm PST before moving to your regular schedule.
You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Maintains clinical expertise and knowledge of scientific progress in nursing and medical arena and incorporates this information into the clinical review and care coordination processes
- Performs clinical review for appropriate utilization of medical services by applying appropriate medical necessity criteria guidelines
- Authorizes healthcare services in compliance with contractual agreements, Health Plan guidelines and appropriate medical necessity criteria
- Documents clinical reviews in care management system. Provide accurate and timely documentation and supporting rational of decision in care management system
- Utilizes care management system and resources to track and analyze utilization, variances and trends, patient outcomes and quality indicators
- Research and prepares clinical information for case review with Physician Leadership for patient treatment and care planning
- Utilizes knowledge of resources available in the health care system to assist the physician and patient effectively
- Identifies members who are appropriate for care coordination programs and collaborates with the Medical Management team for care coordination of the member's needs along the continuum of care
- Successfully completes the Interrater Reliability Testing to ensure consistency of review and application of criteria
- Meets timeliness standards for decision, notification, and prior authorization activities
- Serves as an advocate for all providers and their patients
- Demonstrates a positive attitude and respect for self and others and responds in a courteous manner to all customers, internal and external
- Maintains the confidentiality of all company procedures, results, and information about patients, contracts, and all other proprietary information regarding Optum business
- Performs other duties as required or requested in a positive and helpful manner to enable the department to achieve its goals
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
BASIC QUALIFICATIONS
- Current unrestricted Registered Nurse (RN) license in state of residence (if residing in a multi-state/compact state, nurse must have the multi-state/compact license)
- 3+ years of clinical nursing experience in acute care hospital or LTAC setting
- 1+ years of Utilization Management experience in hospital or insurance setting
- Experience applying Medicare and/or Medicaid guidelines
- Experience with Milliman (MCG) or InterQual guidelines
- Experience researching and preparing clinical information for case review with Physician Leadership for patient treatment and care planning
- Experience providing accurate and timely documentation of clinical review and supporting rational of decision in care management systems
- Experience employing analytical skills necessary for quality case management, utilization review, and quality improvement to meet organizational objectives
- Experience using various computer software applications with an intermediate level of competence, including Microsoft Word and Excel
- Ability to work Monday-Friday 8am-5pm in Pacific Time Zone or Mountain Time Zone to include one weekend day, either Sunday-Thursday or Tuesday-Saturday, after the 3-6 month training period. Training for the first 3-6 months (or potentially longer depending on training progress) will be Monday-Friday 8am-5pm PST before moving to your regular schedule
PREFERRED QUALIFICATIONS
- Inpatient Utilization Management experience
- Utilization Management experience for insurance or managed care organization
- Prior Authorization experience
- Primary residence in Pacific Time Zone or Mountain Time Zone
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
COMPENSATION
- Salary Range: $60,200 to $107,400 annually based on full-time employment
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. We comply with all minimum wage laws as applicable.
APPLICATION DEADLINE
This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
See all 66+ H-1B Visa Utilization Management Nurse Jobs
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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.
H-1B Visa Utilization Management Nurse: 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.