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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Get Access To All JobsINTRODUCTION
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.
UM Nurse Consultant
Fully Remote - WFH
Schedule: Monday - Friday 10:30 AM - 7:30 PM
Position Summary:
UM Nurse Consultant utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs. Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Required Qualifications
- Must have 3+ years of Med Surg experience as an RN in the hospital setting
- Active and unrestricted RN licensure in state of residence
- Able to work in multiple IT platforms/systems
- 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)
Preferred Qualifications
- Knowledge of Medicare/Medicaid
- Managed care experience
- Utilization Management experience
Education
Associates Degree in Nursing required
BSN preferred
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$29.10 - $62.32
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 08/12/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
INTRODUCTION
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.
UM Nurse Consultant
Fully Remote - WFH
Schedule: Monday - Friday 10:30 AM - 7:30 PM
Position Summary:
UM Nurse Consultant utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs. Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Required Qualifications
- Must have 3+ years of Med Surg experience as an RN in the hospital setting
- Active and unrestricted RN licensure in state of residence
- Able to work in multiple IT platforms/systems
- 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)
Preferred Qualifications
- Knowledge of Medicare/Medicaid
- Managed care experience
- Utilization Management experience
Education
Associates Degree in Nursing required
BSN preferred
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$29.10 - $62.32
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 08/12/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
See all 103+ 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.