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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The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). The team's goal is to ensure members receive the appropriate level of care in the most appropriate setting.
As a Utilization Management Registered Nurse:
- You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
- Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers.
- You will complete request determinations within established processing time frames. (i.e. 10 reviews per day?)
- You will communicate with providers, members, or other parties to facilitate care and treatment.
- You will help deliver coordinated care for our members.
- You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
Use your skills to make an impact
Required Qualifications:
- Must hold Compact Registered Nurse (RN) license in your state of residence.
- Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting.
- Must be passionate about contributing to an organization focused on improving consumer experiences.
Preferred Qualifications:
- Previous experience in utilization management/utilization review for a health plan or acute care setting.
- Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
- Experience working in a fully remote, metrics-focused role.
- Experience as an MDS Coordinator or discharge planner in an acute care setting.
- Experience as an RN for a Medicare Certified Home Health agency.
- Health Plan or Medicare / Medicaid Experience.
- Call center or triage experience.
- BSN or bachelor's degree in a related field.
Additional Information
Work-at-Home Information:
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Florida Background Screening Requirements: Notice for candidates applying to this position from a Florida work location, including Florida home-based work location. This position is subject to Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse. For information about the screening process and requirements, visit: https://info.flclearinghouse.com.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Become a part of our caring community
The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). The team's goal is to ensure members receive the appropriate level of care in the most appropriate setting.
As a Utilization Management Registered Nurse:
- You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations.
- Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers.
- You will complete request determinations within established processing time frames. (i.e. 10 reviews per day?)
- You will communicate with providers, members, or other parties to facilitate care and treatment.
- You will help deliver coordinated care for our members.
- You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas.
Use your skills to make an impact
Required Qualifications:
- Must hold Compact Registered Nurse (RN) license in your state of residence.
- Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting.
- Must be passionate about contributing to an organization focused on improving consumer experiences.
Preferred Qualifications:
- Previous experience in utilization management/utilization review for a health plan or acute care setting.
- Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
- Experience working in a fully remote, metrics-focused role.
- Experience as an MDS Coordinator or discharge planner in an acute care setting.
- Experience as an RN for a Medicare Certified Home Health agency.
- Health Plan or Medicare / Medicaid Experience.
- Call center or triage experience.
- BSN or bachelor's degree in a related field.
Additional Information
Work-at-Home Information:
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Florida Background Screening Requirements: Notice for candidates applying to this position from a Florida work location, including Florida home-based work location. This position is subject to Florida Level 2 background screening through the Care Provider Background Screening Clearinghouse. For information about the screening process and requirements, visit: https://info.flclearinghouse.com.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
See all 168+ OPT Utilization Management Nurse Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new OPT Utilization Management Nurse Jobs.
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.