TN Visa Utilization Management Nurse Jobs
Utilization Management Nurse roles qualify for TN visa sponsorship under the USMCA treaty's Registered Nurse category, giving Canadian and Mexican RNs a cap-free path to U.S. employment. You'll need an active U.S. state nursing license and a sponsoring employer to document the UM role as direct nursing practice.
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Get Access To All JobsINTRODUCTION
Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
Who Are We? ✨
Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.
Why Join Us?
We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
JOB SUMMARY
The UM Nurse I - RN performs clinical review of authorization requests to determine medical necessity based on established criteria, regulatory requirements, and organizational policies. This role conducts utilization review activities under established guidelines and escalates complex or non-standard determinations to senior staff or the Medical Director.
FUNCTIONS & JOB RESPONSIBILITIES
- Conduct clinical review of prior authorization requests using approved criteria (e.g., MCG, InterQual).
- Review outpatient and routine inpatient requests.
- Ensure compliance with CMS, state, and contractual turnaround time requirements.
- Document medical necessity determinations clearly and accurately.
- Communicate authorization decisions to providers, members and internal teams.
- Identify cases requiring physician or Medical Director review.
- Participate in concurrent review and discharge planning coordination as assigned.
- Ensure compliance with regulatory timelines.
- Support audit readiness and documentation integrity.
- Additional duties as assigned.
QUALIFICATIONS
Education and Experience
- Active, unrestricted RN license.
- Minimum of three (3) years of clinical experience.
- At least one (1) year in utilization management or case management preferred.
Skills
- Knowledge of medical necessity criteria (MCG/InterQual).
- Understanding of CMS/state UM regulations.
- Strong clinical assessment and documentation skills.
- Ability to manage caseload efficiently.
- Effective provider communication.
- Bilingual proficiency in Cantonese, Mandarin, Spanish, Vietnamese, or Korean preferred.
WAGE RANGE
- Wage Range: $34.98 to $42.85 per hour
PHYSICAL & WORKING ENVIRONMENT
Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:
- Must be able to travel when needed or required.
- Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking).
- Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs. Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly. Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.
Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.
LOCATION
Remote in California only
INTRODUCTION
Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
Who Are We? ✨
Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.
Why Join Us?
We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
JOB SUMMARY
The UM Nurse I - RN performs clinical review of authorization requests to determine medical necessity based on established criteria, regulatory requirements, and organizational policies. This role conducts utilization review activities under established guidelines and escalates complex or non-standard determinations to senior staff or the Medical Director.
FUNCTIONS & JOB RESPONSIBILITIES
- Conduct clinical review of prior authorization requests using approved criteria (e.g., MCG, InterQual).
- Review outpatient and routine inpatient requests.
- Ensure compliance with CMS, state, and contractual turnaround time requirements.
- Document medical necessity determinations clearly and accurately.
- Communicate authorization decisions to providers, members and internal teams.
- Identify cases requiring physician or Medical Director review.
- Participate in concurrent review and discharge planning coordination as assigned.
- Ensure compliance with regulatory timelines.
- Support audit readiness and documentation integrity.
- Additional duties as assigned.
QUALIFICATIONS
Education and Experience
- Active, unrestricted RN license.
- Minimum of three (3) years of clinical experience.
- At least one (1) year in utilization management or case management preferred.
Skills
- Knowledge of medical necessity criteria (MCG/InterQual).
- Understanding of CMS/state UM regulations.
- Strong clinical assessment and documentation skills.
- Ability to manage caseload efficiently.
- Effective provider communication.
- Bilingual proficiency in Cantonese, Mandarin, Spanish, Vietnamese, or Korean preferred.
WAGE RANGE
- Wage Range: $34.98 to $42.85 per hour
PHYSICAL & WORKING ENVIRONMENT
Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:
- Must be able to travel when needed or required.
- Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking).
- Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs. Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly. Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.
Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.
LOCATION
Remote in California only
See all 46+ TN Visa Utilization Management Nurse Jobs
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Get Access To All JobsTips for Finding TN Visa Sponsorship as an Utilization Management Nurse
Verify your nursing license transfers correctly
UM Nurse roles require an active U.S. state RN license, not just a Canadian or Mexican one. Start the NCLEX and endorsement process early, state boards vary on processing time, and you can't file a TN visa petition without a valid U.S. license in hand.
Frame your UM experience as clinical nursing
CBP officers assess whether your role constitutes registered nursing under TN criteria. Emphasize direct clinical decision-making in medical necessity reviews, not administrative or supervisory duties, so your offer letter and support documents clearly satisfy the nursing occupation requirement.
Target health plans and hospital systems with UM departments
Seek employers who already have internal UM teams, such as large hospital networks, integrated health systems, and managed care organizations. These employers understand how to structure a TN support letter for clinical roles and are less likely to conflate UM work with non-qualifying administrative functions.
Use Migrate Mate to find TN-sponsoring UM employers
Search for Utilization Management Nurse positions through Migrate Mate, which filters specifically for TN visa sponsorship opportunities. It saves time identifying which employers have experience sponsoring Canadian and Mexican nurses for U.S. clinical roles.
Understand the Mexican TN cap before accepting an offer
Mexican nationals are subject to a 5,500 annual TN allocation. Confirm with your employer that they initiate USCIS filing well before the fiscal year fills. Canadian citizens can obtain TN status directly at the port of entry, so your entry strategy differs significantly based on citizenship.
Request a detailed employer support letter covering clinical duties
Your offer letter must specify that the position requires registered nursing skills, list your clinical UM responsibilities such as concurrent review and discharge planning authorization, and state your professional credentials. A vague letter citing only cost management or administrative oversight is the most common reason CBP pushes back on UM TN petitions.
Utilization Management Nurse TN Visa: Frequently Asked Questions
Does a Utilization Management Nurse role qualify for TN visa status?
Yes, but the role must be structured as registered nursing practice under USMCA criteria. CBP evaluates whether the position requires clinical nursing judgment, such as conducting medical necessity reviews or authorizing care transitions. Roles framed primarily around administrative coordination or cost oversight without direct clinical decision-making are at higher risk of denial at the port of entry.
How does TN compare to H-1B for Utilization Management Nurses?
TN has no annual lottery and no numerical cap for Canadian citizens, meaning you can pursue a U.S. position without waiting years for a visa slot. H-1B visa requires employer sponsorship through a randomized lottery each spring, with most applicants waiting multiple cycles before selection. TN also processes faster, either at the port of entry for Canadians or through USCIS for Mexican nationals, often in weeks rather than months.
What documents does a UM Nurse need to support a TN petition?
You need a detailed employer offer letter specifying clinical nursing duties, your active U.S. state RN license, proof of Canadian or Mexican citizenship, and your nursing degree or diploma. Some employers also include a USMCA TN support memo from their immigration counsel. CBP at the border or USCIS for Mexican nationals will review all of these before approving status.
Where can I find employers offering TN visa sponsorship for UM Nurse roles?
Migrate Mate is built specifically for Canadian and Mexican professionals searching for TN visa sponsorship opportunities in the United States. You can filter for Utilization Management Nurse roles where the employer has indicated TN sponsorship, which removes the guesswork of cold-applying to companies unfamiliar with the USMCA treaty process.
Can a Mexican RN renew TN status for a Utilization Management Nurse position?
Yes, TN status is renewable in three-year increments with no maximum limit on renewals, for both Canadian and Mexican nationals. Mexican RNs renew through USCIS by filing a new petition before the current status expires. Canadians can renew at a port of entry. You'll need updated employer documentation and a valid U.S. nursing license at each renewal cycle.