H-1B Visa Utilization Review Nurse Jobs
Utilization Review Nurses assess medical necessity and coordinate care approvals, making the role a recognized specialty occupation for H-1B classification. Employers in managed care, health insurance, and hospital systems routinely sponsor H-1B visas for RNs in UR roles, particularly those with BSN credentials and clinical experience in case management or prior authorization.
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Get Access To All JobsBy joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Utilization Review Nurse (RN)
PRIMARY PURPOSE: To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes.
ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Identifies treatment plan request(s) and obtains and analyzes medical records that support the request.
- Clarifies unclear treatment plan requests by contacting the requesting provider's office.
- Utilizes evidence-based criteria and jurisdictional guidelines to form utilization review determinations.
- Pursues Physician Advisor services when treatment plan requests do not meet evidenced-based criteria.
- Negotiates treatment plan requests with requesting provider when medically appropriate and jurisdictionally allowed.
- Channels certified treatment plan requests to preferred vendors as necessary.
- Documents all utilization review outcomes in utilization review software.
- Communicates and works with claim examiners as needed to provide clinical information to resolve issues.
- Maintains a score of 90% or higher on monthly internal utilization review audits.
- Meets productivity goals as outlined by supervisor.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
QUALIFICATIONS
Education & Licensing
Active unrestricted RN license in a state or territory of the United States required. Associate degree from an accredited college or university required. Bachelor’s degree from an accredited college or university preferred. Utilization review based certification preferred.
Experience
Four (4) years of related experience or equivalent combination of education and experience required to include two (2) years of recent clinical practice or one (1) year of recent utilization review.
Skills & Knowledge
- Strong clinical practice knowledge
- Knowledge of the insurance industry and claims processing
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Excellent interpersonal skills
- Excellent negotiation skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
TAKING CARE OF YOU BY
- We offer a diverse and comprehensive benefits package including:
- Three Medical, and two dental plans to choose from.
- Tuition reimbursement eligible.
- 401K plan that matches 50% on every $ you put in up to the first 6% you save.
- 4 weeks PTO your first full year.
NEXT STEPS
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Utilization Review Nurse (RN)
PRIMARY PURPOSE: To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes.
ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Identifies treatment plan request(s) and obtains and analyzes medical records that support the request.
- Clarifies unclear treatment plan requests by contacting the requesting provider's office.
- Utilizes evidence-based criteria and jurisdictional guidelines to form utilization review determinations.
- Pursues Physician Advisor services when treatment plan requests do not meet evidenced-based criteria.
- Negotiates treatment plan requests with requesting provider when medically appropriate and jurisdictionally allowed.
- Channels certified treatment plan requests to preferred vendors as necessary.
- Documents all utilization review outcomes in utilization review software.
- Communicates and works with claim examiners as needed to provide clinical information to resolve issues.
- Maintains a score of 90% or higher on monthly internal utilization review audits.
- Meets productivity goals as outlined by supervisor.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
QUALIFICATIONS
Education & Licensing
Active unrestricted RN license in a state or territory of the United States required. Associate degree from an accredited college or university required. Bachelor’s degree from an accredited college or university preferred. Utilization review based certification preferred.
Experience
Four (4) years of related experience or equivalent combination of education and experience required to include two (2) years of recent clinical practice or one (1) year of recent utilization review.
Skills & Knowledge
- Strong clinical practice knowledge
- Knowledge of the insurance industry and claims processing
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Excellent interpersonal skills
- Excellent negotiation skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
TAKING CARE OF YOU BY
- We offer a diverse and comprehensive benefits package including:
- Three Medical, and two dental plans to choose from.
- Tuition reimbursement eligible.
- 401K plan that matches 50% on every $ you put in up to the first 6% you save.
- 4 weeks PTO your first full year.
NEXT STEPS
If your application is selected to advance to the next round, a recruiter will be in touch.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
See all 30+ Utilization Review Nurse jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new Utilization Review Nurse roles.
Get Access To All JobsTips for Finding H-1B Visa Sponsorship as an Utilization Review Nurse
Check prevailing wages before negotiating
Use the OFLC Wage Search to look up Level I through Level IV wages for Registered Nurses in your target metro area. Your offered salary must meet the certified LCA wage, so knowing the floor protects you during offer negotiations.
Target managed care and insurance employers
Health insurers and utilization management organizations file H-1B petitions for UR nurses more consistently than staffing agencies. Search Migrate Mate to find employers with verified H-1B LCA filing history specifically in UR and case management roles.
Gather your NCLEX and licensure documents early
Your employer's immigration counsel will need your active RN license, NCLEX pass documentation, and BSN transcripts for the H-1B petition. Multi-state compact licenses simplify remote UR roles but confirm your license covers the employer's filing state.
Ask about cap-exempt employer options
Hospitals affiliated with nonprofit research institutions or universities may qualify as cap-exempt H-1B sponsors, letting you start without waiting for the April lottery. UR nurses employed by academic medical centers should ask HR whether the facility holds cap-exempt status.
Clarify remote work LCA requirements at offer
Remote UR roles require the employer to file a separate LCA for each state where you work. Before accepting a fully remote offer, confirm your employer is prepared to certify worksite locations with DOL, since incomplete LCA coverage is a common compliance issue.
Utilization Review Nurse jobs are hiring across the US. Find yours.
Find Utilization Review Nurse JobsUtilization Review Nurse H-1B Visa: Frequently Asked Questions
Does a Utilization Review Nurse role qualify as a specialty occupation for H-1B purposes?
Yes, if the position requires a BSN or higher as a minimum entry requirement. USCIS evaluates specialty occupation status based on the degree requirement attached to the specific role, not the job title. Ensure your offer letter and the employer's internal job description both specify a bachelor's degree in nursing, not a more general healthcare credential, to support the petition.
Which types of employers sponsor H-1B visas for Utilization Review Nurses?
Health insurers, managed care organizations, hospital systems with in-house UR departments, and third-party utilization management vendors are the most active H-1B sponsors for this role. Staffing agencies can also file H-1B petitions but require a valid end-client employer relationship. Browse Migrate Mate to identify employers with confirmed LCA filing history in UR and case management occupations.
Can I work remotely as a Utilization Review Nurse on an H-1B visa?
Yes, but your employer must certify a Labor Condition Application that covers every state where you perform work. For fully remote UR roles, DOL requires a separate LCA for each physical worksite location, including your home address. If you relocate or work from multiple states, your employer must update the LCA accordingly to remain compliant.
Does my RN license need to match the state where my H-1B employer is based?
Your license must cover the state where work is actually performed, not necessarily where the employer is incorporated. For remote UR positions, that means your home state. Nurses holding a Nurse Licensure Compact license cover most member states automatically, but you'll need individual state licenses for non-compact states. Confirm your license coverage before signing an offer for a remote role.
How does the H-1B lottery affect my timeline for starting a Utilization Review Nurse position?
Cap-subject H-1B petitions are filed in April for an October 1 start date, meaning a job offer accepted in early spring won't translate to authorized work until the following fiscal year. If your target employer is a nonprofit hospital or academic medical center with cap-exempt status, this delay doesn't apply and employment can begin as soon as USCIS approves the petition.
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