OPT Utilization Management Specialist Jobs
Utilization Management Specialist roles sit at the intersection of clinical knowledge and insurance decision-making, making them a strong OPT fit for students with healthcare, nursing, or public health backgrounds. Most positions require a clinical license and fall under STEM-adjacent health informatics or managed care fields, which can support a 24-month STEM OPT extension depending on your degree.
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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 Specialist Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new OPT Utilization Management Specialist Jobs.
Get Access To All JobsTips for Finding OPT Sponsorship as an Utilization Management Specialist
Confirm your OPT end date before applying
Utilization management hiring cycles can run six to ten weeks. Know your OPT expiration date before applying so you can flag timeline constraints early and avoid accepting an offer you cannot legally start before authorization lapses.
Highlight clinical licensure on your resume
Most UM Specialist roles require an active RN, LPN, or similar clinical license. Lead with your license number and state of issuance prominently. Employers screening candidates often filter by licensure before reviewing immigration status or work authorization type.
Research whether your degree qualifies for STEM OPT extension
Health informatics, clinical data analytics, and public health degrees from STEM-designated programs qualify for a 24-month extension. Confirming this before interviews lets you present a longer work authorization window, which meaningfully reduces employer concern about short timelines.
Target managed care organizations and health insurers directly
Large managed care organizations, regional health plans, and hospital systems with in-house utilization departments sponsor OPT more reliably than staffing agencies. Direct employer applications give you a cleaner path to H-1B visa sponsorship when your OPT period ends.
Ask about H-1B sponsorship policy before the final interview round
Raise sponsorship early but professionally, ideally after you have demonstrated fit. Asking whether the organization has sponsored H-1B visas for UM roles previously signals awareness without putting the employer on the defensive before an offer is on the table.
Prepare documentation showing your authorization is current
Have your EAD card, I-20 with OPT approval notation, and SEVP portal confirmation ready to share with HR. Utilization management employers in healthcare are compliance-conscious and appreciate candidates who arrive organized with complete work authorization paperwork.
Utilization Management Specialist OPT: Frequently Asked Questions
Can F-1 OPT students legally work as Utilization Management Specialists?
Yes. F-1 students authorized for OPT can work as Utilization Management Specialists as long as the role is directly related to their field of study. Degrees in nursing, health informatics, public health, or clinical data analytics typically satisfy the relatedness requirement. Confirm the connection with your DSO before accepting an offer.
Do Utilization Management Specialist jobs qualify for the STEM OPT extension?
It depends on your specific degree, not the job title. If your degree is from a STEM-designated program such as health informatics, biomedical informatics, or data science, and your employer is enrolled in E-Verify, you can apply for a 24-month STEM OPT extension. Check your degree's CIP code against the official STEM OPT Designated Degree Program List.
How far in advance should I start applying for UM Specialist roles during OPT?
Start at least three to four months before your OPT start date or current authorization expiration. Utilization management hiring cycles involve clinical credential verification, background checks, and payer-specific onboarding, which collectively add four to six weeks beyond the standard interview process. You can browse open UM Specialist positions on Migrate Mate to get a sense of current employer timelines.
Will employers require a clinical license even if I have a health informatics background?
Most direct-care UM Specialist roles require an active RN or LPN license. However, some payers and managed care organizations hire candidates with health informatics or clinical data backgrounds into UM analyst or coordinator roles that do not require a clinical license. Review the specific job posting carefully and clarify licensure expectations during the initial recruiter screen.
What happens to my OPT employment authorization if my UM Specialist employer is acquired or restructures?
If your employer is acquired through a merger or stock purchase and the legal employing entity does not change, your OPT authorization typically continues uninterrupted. If the legal entity changes or you are transferred to a new subsidiary, report the change to your DSO within 10 days and update your SEVP portal record to avoid a compliance violation.