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.
Find H-1B Visa Utilization Management Nurse JobsOverview
Showing 5 of 137+ Utilization Management Nurse jobs
See all 137+ 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 Requirements
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.
Responsibilities and Tasks
- Performs timely and accurate utilization review for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer.
- Communicates with case manager, 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.
- HINN discussions/Observation Education.
- Assists Case Manager in Avoidable Days Collection.
- Ownership of Regulatory Compliance related to Utilization Management conditions of participation.
- Assures appropriate reimbursement and stewardship of organizational and patient resources.
- Actively reports opportunities to improve reimbursement and responds to relevant data.
- Collaborates with admitting specialists regarding authorization policies and procedures of third party payers.
- Remains current on clinical practice and protocols impacting clinical reimbursement.
- Participates in department improvement initiatives.
- Serves to orient and educate Utilization Manager 1s.
- Provides oversight and education to utilization management interns placed in the practice area.
Education and Experience
- Licensure as a Registered Nurse or other equivalent health care license in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required.
- Minimum of 12 months experience in case management or utilization management required.
Knowledge, Skills and Abilities
- Knowledge of utilization management is required.
- 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.
Patient Safety
Ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.
- Takes action to correct observed risks to patient safety.
- Reports adverse events and near misses to appropriate management authority.
- Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.
Job Requirements
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.
Responsibilities and Tasks
- Performs timely and accurate utilization review for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer.
- Communicates with case manager, 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.
- HINN discussions/Observation Education.
- Assists Case Manager in Avoidable Days Collection.
- Ownership of Regulatory Compliance related to Utilization Management conditions of participation.
- Assures appropriate reimbursement and stewardship of organizational and patient resources.
- Actively reports opportunities to improve reimbursement and responds to relevant data.
- Collaborates with admitting specialists regarding authorization policies and procedures of third party payers.
- Remains current on clinical practice and protocols impacting clinical reimbursement.
- Participates in department improvement initiatives.
- Serves to orient and educate Utilization Manager 1s.
- Provides oversight and education to utilization management interns placed in the practice area.
Education and Experience
- Licensure as a Registered Nurse or other equivalent health care license in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required.
- Minimum of 12 months experience in case management or utilization management required.
Knowledge, Skills and Abilities
- Knowledge of utilization management is required.
- 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.
Patient Safety
Ensures patient safety in the performance of job functions and through participation in hospital, department or unit patient safety initiatives.
- Takes action to correct observed risks to patient safety.
- Reports adverse events and near misses to appropriate management authority.
- Identifies possible risks in processes, procedures, devices and communicates the same to those in charge.
See all 137+ H-1B Visa Utilization Management Nurse Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new H-1B Visa Utilization Management Nurse Jobs.
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.