OPT Utilization Management Nurse Jobs
Utilization Management Nurse jobs are a strong fit for F-1 OPT students with a nursing or healthcare management background. These roles are typically office-based or remote, which matters for OPT because your employer must be a single, verifiable organization. STEM OPT extension is not available for standard RN-track roles unless your degree falls under a STEM-designated CIP code.
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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 61+ OPT Utilization Management Nurse Jobs
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Get Access To All JobsTips for Finding OPT Sponsorship as an Utilization Management Nurse
Confirm your employer is OPT-eligible
UM Nurse roles are often filled through staffing agencies or managed care organizations. Make sure your direct employer, the entity signing your offer letter, is a legitimate business with an EIN and can verify your employment for SEVP reporting purposes.
Check your active OPT dates before applying
Your OPT period is tied to your EAD card dates. UM roles take weeks to hire, so apply early enough that your EAD will remain valid through onboarding. Starting a job even one day before or after your EAD dates is a status violation.
Clarify remote work arrangements with your DSO
Many UM Nurse positions are fully remote. SEVP requires a reportable employer address on your SEVIS record. Confirm with your DSO how to properly report a remote role so your record stays compliant throughout your OPT period.
Highlight clinical utilization skills in your resume
UM roles prioritize InterQual or Milliman criteria knowledge, payer authorization experience, and case review. Candidates who surface these skills clearly in their resume move faster through screening, which matters when you have a fixed OPT window.
Target managed care organizations and large health systems
National insurers and large health systems hire UM nurses at scale and typically have established HR processes for work authorization. Smaller clinical practices often lack the infrastructure to onboard international employees compliantly. Focus your search accordingly.
Use Migrate Mate to find OPT-friendly UM Nurse openings
Not all job boards filter for OPT compatibility. Migrate Mate surfaces roles from employers with a track record of sponsoring or hiring international candidates, saving you time and reducing the risk of pursuing roles that will stall at authorization.
Utilization Management Nurse OPT: Frequently Asked Questions
Can I work as a Utilization Management Nurse on F-1 OPT?
Yes, if your OPT is authorized for healthcare or nursing and your degree is in a qualifying field. Utilization Management is considered practice related to nursing, so it generally satisfies the OPT requirement that your job be directly related to your major. Confirm the connection with your DSO before accepting an offer if your degree is in a non-clinical health field.
Do Utilization Management Nurse jobs qualify for the STEM OPT extension?
Only if your nursing or health informatics degree was awarded under a STEM-designated CIP code. Most traditional BSN and MSN programs are not STEM-designated, which means you would have 12 months of OPT rather than 36. If you have a degree in health informatics, biomedical engineering, or a related STEM field and are applying to a UM role, verify your CIP code with your DSO.
Will employers sponsor H-1B for Utilization Management Nurse roles?
Some do, particularly large managed care organizations and national insurers that hire UM nurses at volume. H-1B visa eligibility depends on the role being classified as a specialty occupation requiring at least a bachelor's degree in a specific field. UM Nurse positions typically meet that standard given the clinical review and case management complexity involved. Browse Migrate Mate to identify employers with a history of sponsoring these roles.
How should I report a fully remote Utilization Management Nurse job during OPT?
Remote work on OPT requires a valid, reportable employer address in your SEVIS record. You cannot list your home address as your employer's address. Your employer must have a principal place of business that your DSO can enter in SEVIS. Notify your DSO as soon as you receive an offer and before your start date so your record is updated correctly.
What licensing requirements should I be aware of when job searching on OPT?
Most UM Nurse positions require an active, unrestricted RN license in at least one U.S. state, and some employers require licensure in the states where the patients are located. Compact license states simplify multi-state coverage. Verify your license is active and in good standing before applying, and factor in any renewal timelines relative to your OPT expiration date.