TN Visa Utilization Management Specialist Jobs
Utilization Management Specialist roles qualify for TN visa sponsorship under the USMCA treaty's Medical/Health Information Specialist category, requiring a relevant bachelor's degree in health administration, nursing, or a clinical field. Canadian citizens can apply at any port of entry; Mexican citizens go through consular processing. No lottery, no cap uncertainty.
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Get Access To All JobsCareers With Purpose
Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Facility: Marsh Security Hlth Plan
Location: Marshfield, WI
Address: 1515 N St Joseph Ave, Marshfield, WI 54449, USA
Shift: Day
Job Schedule: Full time
Weekly Hours: 40.00
Salary Range: $24.00 - $38.50
Department Details
Join the Health Plan Utilization Management team and leverage your RN expertise to conduct medical necessity reviews to ensure members receive appropriate, high-quality care.
Core Hours: Monday through Friday, 8am to 5pm, No weekends or holidays
Job Summary
Conduct level of care medical necessity reviews within patient’s medical records. Performs utilization management (UM) activities in accordance with UM plan to assure compliance with accreditation/regulatory requirements. Completes/coordinates activities relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. Completes activities relating to determination of medical necessity, authorization, continued stay review including diagnosis and procedural coding for working diagnosis related group (DRG) assignments. Workflows may include patient chart review, and assisting with and managing of insurance coverage and denials, prior authorizations, scheduled procedures, same-day readmission reviews, as well as length of stay. Ensure validation of appropriate level of care for pre-admission surgical reviews prior to admission. Reviews include InterQual clinical decision support criteria to ensure both the appropriateness of medical services and effective cost control. Ability to determine appropriate action for referring cases that do not meet departmental standards and require additional secondary review and/or escalation as needed.
May also be actively involved in collaborating with members of the healthcare team to promote medically necessary resource utilization and achievement of fiscal outcomes when appropriate. Collaborates with physicians and other clinical professionals as needed to assist in documentation improvement practices for effective and appropriate services. Dynamic and tactful interpersonal skills, particularly in relating to physicians and other health care professionals. Educates members of the healthcare team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization.
Assists the department in monitoring the utilization of resources, risk management and quality of care for patients in accordance with guidelines and criteria. Assist in report preparation, correspondence, and maintenance of appropriate records. Ensure services comply with professional standards, national and local coverage determinations (NCD/LCD), centers for Medicare and Medicaid services (CMS), as well as state and federal regulatory requirements. Maintain working knowledge of payer standards for UM functions for authorization requirements.
May assist with additional special projects related to work, upcoming initiatives, new organizational goals and audits when delegated. Considered a resource to all team members and acts as a point of contact for guidance, training, and assisting with questions. Demonstrate flexibility and adaptability where scheduling may fluctuate due to communication needs within interdepartmental and clinical units are required.
Qualifications
Bachelor's degree in nursing preferred. Graduate from a nationally accredited nursing program required, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).
Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing. Obtains and subsequently maintains required department specific competencies and certifications.
Benefits
Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits.
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org.
Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0255263
Job Function: Care Coordination
Featured: No
Careers With Purpose
Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Facility: Marsh Security Hlth Plan
Location: Marshfield, WI
Address: 1515 N St Joseph Ave, Marshfield, WI 54449, USA
Shift: Day
Job Schedule: Full time
Weekly Hours: 40.00
Salary Range: $24.00 - $38.50
Department Details
Join the Health Plan Utilization Management team and leverage your RN expertise to conduct medical necessity reviews to ensure members receive appropriate, high-quality care.
Core Hours: Monday through Friday, 8am to 5pm, No weekends or holidays
Job Summary
Conduct level of care medical necessity reviews within patient’s medical records. Performs utilization management (UM) activities in accordance with UM plan to assure compliance with accreditation/regulatory requirements. Completes/coordinates activities relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. Completes activities relating to determination of medical necessity, authorization, continued stay review including diagnosis and procedural coding for working diagnosis related group (DRG) assignments. Workflows may include patient chart review, and assisting with and managing of insurance coverage and denials, prior authorizations, scheduled procedures, same-day readmission reviews, as well as length of stay. Ensure validation of appropriate level of care for pre-admission surgical reviews prior to admission. Reviews include InterQual clinical decision support criteria to ensure both the appropriateness of medical services and effective cost control. Ability to determine appropriate action for referring cases that do not meet departmental standards and require additional secondary review and/or escalation as needed.
May also be actively involved in collaborating with members of the healthcare team to promote medically necessary resource utilization and achievement of fiscal outcomes when appropriate. Collaborates with physicians and other clinical professionals as needed to assist in documentation improvement practices for effective and appropriate services. Dynamic and tactful interpersonal skills, particularly in relating to physicians and other health care professionals. Educates members of the healthcare team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization.
Assists the department in monitoring the utilization of resources, risk management and quality of care for patients in accordance with guidelines and criteria. Assist in report preparation, correspondence, and maintenance of appropriate records. Ensure services comply with professional standards, national and local coverage determinations (NCD/LCD), centers for Medicare and Medicaid services (CMS), as well as state and federal regulatory requirements. Maintain working knowledge of payer standards for UM functions for authorization requirements.
May assist with additional special projects related to work, upcoming initiatives, new organizational goals and audits when delegated. Considered a resource to all team members and acts as a point of contact for guidance, training, and assisting with questions. Demonstrate flexibility and adaptability where scheduling may fluctuate due to communication needs within interdepartmental and clinical units are required.
Qualifications
Bachelor's degree in nursing preferred. Graduate from a nationally accredited nursing program required, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).
Currently holds an unencumbered registered nurse (RN) license with the State Board of Nursing. Obtains and subsequently maintains required department specific competencies and certifications.
Benefits
Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits.
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org.
Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Req Number: R-0255263
Job Function: Care Coordination
Featured: No
See all 5+ Utilization Management Specialist jobs
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Get Access To All JobsTips for Finding TN Visa Sponsorship as an Utilization Management Specialist
Align your credentials to clinical criteria
TN approval for this role depends on demonstrating a direct link between your degree field and utilization review work. A nursing or health information degree travels better than a general business credential, so request official transcripts and a credential evaluation before applying.
Target health systems with utilization departments
Large hospital networks, managed care organizations, and third-party administrators run dedicated UM teams and file TN petitions regularly. Filter your search to employers with in-house HR or immigration coordinators who already understand the Medical/Health Information Specialist category.
Clarify TN eligibility before the offer stage
Ask the hiring manager during final interviews whether their HR team has processed TN visas before. An employer unfamiliar with TN may default to H-1B timelines, stalling your start date when a same-day Canadian port-of-entry approval was available the whole time.
Use Migrate Mate to find sponsoring employers
Search for Utilization Management Specialist roles with confirmed TN sponsorship using Migrate Mate, which filters positions by visa type so you're not sorting through listings that exclude Canadian and Mexican applicants or require H-1B status only.
Prepare your support letter with specific UM functions
Your employer's TN support letter must describe your duties in clinical review terms, such as applying InterQual or Milliman criteria, coordinating with payers, and managing prior authorization workflows. Generic job descriptions increase the risk of a secondary inspection at the border.
Understand Mexican TN processing before accepting an offer
Mexican citizens cannot use the Canadian port-of-entry shortcut and must attend a U.S. consular appointment. Factor four to eight weeks of consular scheduling into your start-date negotiation so the employer sets a realistic onboarding timeline from day one.
Utilization Management Specialist jobs are hiring across the US. Find yours.
Find Utilization Management Specialist JobsUtilization Management Specialist TN Visa: Frequently Asked Questions
Does a Utilization Management Specialist role qualify for a TN visa?
Yes, if your duties center on clinical review, prior authorization, or health information analysis. USCIS and CBP assess TN eligibility under the Medical/Health Information Specialist category. Your offer letter and employer support documentation must describe your responsibilities in those specific terms, and your degree must correspond to the clinical or health information field rather than a generalist discipline.
How does TN visa sponsorship compare to H-1B for this role?
TN has no annual cap and no lottery, so Canadian professionals can receive approval at a port of entry on the same day they present their documents, while H-1B requires a lottery registration in March and a start date no earlier than October 1. For Utilization Management Specialists with a qualifying degree, TN is almost always faster and more predictable than waiting through the H-1B cycle.
What degree do I need to qualify as a TN Utilization Management Specialist?
A bachelor's degree in nursing, health information management, health sciences, or a closely related clinical field is the standard basis for TN approval in this category. A degree in business or general healthcare administration may be accepted if your transcript and the job description both emphasize clinical or medical information components, but the connection must be explicit and documented.
How do I find Utilization Management Specialist jobs that offer TN visa sponsorship?
Most standard job listings don't specify TN eligibility, which means you can spend hours filtering out roles restricted to U.S. citizens or H-1B holders only. Migrate Mate lets you search specifically for UM Specialist positions with confirmed TN sponsorship, so you're connecting directly with employers who already understand the visa category and are open to Canadian and Mexican applicants.
Can I switch employers while working in the U.S. on a TN visa as a Utilization Management Specialist?
Yes. TN status is employer-specific, so you need a new TN approval before or at the time you start with a new organization. Canadian citizens can obtain the new TN at a port of entry on the day they begin the new role. Mexican citizens must go through consular processing, which requires scheduling time. Your previous employer's TN does not transfer automatically.
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