OPT Utilization Review Nurse Jobs
Utilization Review Nurse jobs are a strong fit for F-1 OPT students with a nursing degree and clinical background. These roles typically require an active RN license, which can complicate OPT timelines. Most positions are full-time and STEM OPT extension is not available for this role.
Find OPT Utilization Review Nurse JobsOverview
Showing 5 of 26+ Utilization Review Nurse jobs
See all 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 JobsINTRODUCTION
Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 26 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2025-2026 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 63 high-performing honors.
What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients' shoes ourselves and that shared experience fuels our commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact – because when it comes to caring for people, we're all in.
At Baptist Health, we’re committed to supporting our employees at every stage of their journey, both personally and professionally. Our approach is rooted in a “grow our own” philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including:
- Career growth and development opportunities, with clear pathways and ongoing support
- Comprehensive health and wellness resources that go beyond traditional benefits
- A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs
- Tuition reimbursement to support continued learning and advancement
- And so much more
Together, these benefits and others reflect our commitment to caring for our people, so they can build fulfilling careers with us while making a meaningful impact every day.
DESCRIPTION:
The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry. Facilitates communication between payers, review agencies, healthcare team. Identify delays in treatment or inappropriate utilization and serves as a resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates to resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments. Estimated salary range for this position is $75,337.60 - $100,199.01 / year depending on experience.
QUALIFICATIONS
Degrees:
- Associates.
Licenses & Certifications:
- MCG Care Guidelines Specialist.
- Registered Nurse.
Additional Qualifications:
- RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN; however, they are required to complete the BSN within 3 years of job entry date.
- MCG Specialist Certification ISC/HRC required within 12 months of job entry date.
- 3 years of Nursing experience preferred.
- Excellent written, interpersonal communication and negotiation skills.
- Strong critical thinking skills and the ability to perform clinical/chart review abstract information efficiently.
- Strong analytical, data management and computer skills.
- Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
- Current working knowledge of payer and managed care reimbursement preferred.
- Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families.
- Knowledgeable in local, state, and federal legislation and regulations.
- Ability to tolerate high volume production standards.
Minimum Required Experience: 3 Years
EOE, including disability/vets
INTRODUCTION
Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 26 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2025-2026 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 63 high-performing honors.
What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients' shoes ourselves and that shared experience fuels our commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact – because when it comes to caring for people, we're all in.
At Baptist Health, we’re committed to supporting our employees at every stage of their journey, both personally and professionally. Our approach is rooted in a “grow our own” philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including:
- Career growth and development opportunities, with clear pathways and ongoing support
- Comprehensive health and wellness resources that go beyond traditional benefits
- A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs
- Tuition reimbursement to support continued learning and advancement
- And so much more
Together, these benefits and others reflect our commitment to caring for our people, so they can build fulfilling careers with us while making a meaningful impact every day.
DESCRIPTION:
The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry. Facilitates communication between payers, review agencies, healthcare team. Identify delays in treatment or inappropriate utilization and serves as a resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates to resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments. Estimated salary range for this position is $75,337.60 - $100,199.01 / year depending on experience.
QUALIFICATIONS
Degrees:
- Associates.
Licenses & Certifications:
- MCG Care Guidelines Specialist.
- Registered Nurse.
Additional Qualifications:
- RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN; however, they are required to complete the BSN within 3 years of job entry date.
- MCG Specialist Certification ISC/HRC required within 12 months of job entry date.
- 3 years of Nursing experience preferred.
- Excellent written, interpersonal communication and negotiation skills.
- Strong critical thinking skills and the ability to perform clinical/chart review abstract information efficiently.
- Strong analytical, data management and computer skills.
- Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
- Current working knowledge of payer and managed care reimbursement preferred.
- Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families.
- Knowledgeable in local, state, and federal legislation and regulations.
- Ability to tolerate high volume production standards.
Minimum Required Experience: 3 Years
EOE, including disability/vets
See all OPT Utilization Review Nurse Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new OPT Utilization Review Nurse Jobs.
Get Access To All JobsTips for Finding OPT Sponsorship as an Utilization Review Nurse
Confirm your RN license is active before applying
Utilization review roles require an active, unrestricted RN license in the state where you'll work. Verify your license is in good standing before submitting applications. Licensing delays can directly impact your OPT start date and employment authorization.
Target employers with existing OPT hiring experience
Large hospital systems, national insurers, and managed care organizations are more likely to have hired OPT workers before. Smaller clinics may not understand work authorization requirements, which slows hiring significantly and puts your OPT timeline at risk.
Apply early and account for onboarding lead time
Utilization review hiring often involves credentialing checks and compliance reviews before your start date. Start applying at least 60 to 90 days before your OPT begins to leave enough time for background checks and employer paperwork.
Be explicit about OPT authorization in your cover letter
Clearly state that you're authorized to work on OPT and specify your authorization end date. Confusion about work authorization is one of the most common reasons OPT candidates get screened out before a hiring manager even reviews the application.
Highlight clinical decision-making experience in your resume
Utilization review employers look for nurses with strong clinical judgment, not just bedside experience. Emphasize any prior authorization, case management, or discharge planning work. These experiences map directly to the core responsibilities of the role.
Ask about H-1B sponsorship during the offer stage
OPT lasts 12 months for nursing graduates without STEM extension eligibility. Raise the H-1B visa sponsorship question after you have an offer in hand. Larger employers in managed care and insurance are more likely to sponsor than smaller practice groups.
Utilization Review Nurse OPT: Frequently Asked Questions
Can F-1 OPT students work as Utilization Review Nurses?
Yes, F-1 OPT students can work as Utilization Review Nurses as long as the role is directly related to their nursing degree. You'll need an active RN license in the state where you work. OPT authorization covers full-time employment, and the role must align with your field of study as listed on your EAD.
Is the Utilization Review Nurse role eligible for the STEM OPT extension?
No. Nursing falls under CIP code 51.38, which is not on the STEM Designated Degree Program list. That means you're limited to 12 months of post-completion OPT without an extension. If you want to continue working in the U.S. after OPT ends, your employer will need to sponsor an H-1B or other work visa.
How do I find employers willing to hire OPT nurses for utilization review roles?
Browse Migrate Mate to find Utilization Review Nurse roles posted by employers with a track record of hiring OPT and visa-sponsored candidates. Large managed care organizations, national health insurers, and hospital-owned utilization management departments tend to be the most OPT-friendly employers in this specialty.
Does an active RN license affect my ability to start work on OPT?
Yes, and it's one of the most common delays OPT nurses face. Your employment must begin on or after your OPT start date and requires both an active EAD and a valid RN license. If your license is pending or under review, you cannot legally begin work, even if your EAD has already been issued.
Can I work remotely as a Utilization Review Nurse on OPT?
Yes, many utilization review roles are fully remote or hybrid, which is an advantage for OPT workers. However, most states require your RN license to be active in the state where your employer is headquartered or where the patients you review are located. Confirm licensure requirements with your employer before accepting a remote offer.