Utilization Management Nurse Jobs in USA with Visa Sponsorship
Utilization Management Nurses are in high demand across U.S. health systems, and many employers sponsor H-1B visa and TN visas for qualified RNs. Your clinical background and licensure are the core requirements, this role consistently clears the specialty occupation threshold. For detailed occupation requirements, see the O*NET profile.
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Get Access To All JobsJob Description Summary
Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to The Utilization Management Nurse (UMN) reports to the Manager of Case Management and Care Transitions. Under general guidance of the Nurse Case Manager Team Leader of the Service Line, the UM Nurse functions as a member of the clinical service line team facilitates optimal reimbursement through accurate certification of their assigned patients. This position conducts initial admission reviews and refers cases for secondary review when appropriate. This role ensures the adherence to regulatory requirements with Medicare, FFS Medicaid, and other government payers. The UM Nurse refers and consults with the multidisciplinary team to promote appropriate communication of the review results to hospital revenue professionals to ensure proper utilization of hospital resources for accurate reimbursement.
Entity
Medical University Hospital Authority (MUHA)
Worker Type
Employee
Worker Sub-Type
Regular
Cost Center
CC005339 SYS - Utilization Management
Pay Rate Type
Salary
Pay Grade
Health-28
Scheduled Weekly Hours
40
Work Shift
Job Description
Hours per week: 40
Scheduled Work Hours/Shift: Days
Fair Labor Standards Act Status: Salaried
Job Summary/Purpose: Conducts utilization reviews to determine if patients are receiving care appropriate to severity of illness or condition and intensity of services required. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with providers and other stakeholders as needed.
Minimum Training and Education: Bachelor's degree in Nursing from an accredited school of nursing and five years of nursing work experience to include two years utilization / case management experience in a hospital setting required. Prior leadership experience preferred. Evidence of committee involvement within a healthcare setting needed (either departmental or hospital-wide). Must possess excellent verbal and written communication skills. Familiarity with InterQual and/or MCG screening criteria desired.
Required Licensure, Certifications, Registrations: Licensure as a registered nurse by the state of South Carolina or compact state required.
Physical Requirements:
(C)ontinuous = 6-8 hours per shift; (F)requent = 2-6 hours per shift; (I)nfrequent = 0-2 hours per shift) Ability to perform job junctions while standing (C), while sitting (I), while walking (F). Ability to climb stairs (I); work indoors (C); work from elevated areas (I); work in confined/cramped spaces (I); perform job functions from kneeling positions (I); bend at the waist (F); twist at the waist (F); squat and perform job functions(I); perform ‘pinching’ operations (I); and fully use both hands/arms (C). Ability to perform repetitive motions with hands/wrists/elbows and shoulders (F), ability to fully use both legs (C), to reach in all directions, possess good finger dexterity (C), maintain tactile sensory functions (C) and maintain good olfactory sensory function (C). Ability to lift and carry up to 50 lbs, unassisted and lift/carry patients up to 350 lbs (+/-), assisted. Ability to lift objects from floor level to height of 36 inches, up to 50 lbs, unassisted. Ability to lower objects, to 50 lbs, from height of 36 inches, unassisted. Ability to push/pull objects up to 350 lbs (+/-), unassisted. Maintain 20/40 vision, corrected. (C), see and recognize objects close at hand (C) and objects at a distance (C). Ability to match or discriminate between colors (C), to determine distance/relationship between objects; depth perception. (C) and good peripheral vision capabilities (C). Ability to maintain hearing acuity, with correction (C), ability to hear and understand whispered conversations at a distance of three feet, must be ambidextrous. Ability to perform gross motor functions with frequent fine motor movements (C). Ability to be qualified physically (by medical personnel) for respirator use, initially and annually. Ability to deal effectively with stressful situations. Computer literacy, ability to work rotating shifts, provide extended leadership coverage as needed, ability to learn and use new processes, tools equipment as required.
If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees
Job Description Summary
Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to The Utilization Management Nurse (UMN) reports to the Manager of Case Management and Care Transitions. Under general guidance of the Nurse Case Manager Team Leader of the Service Line, the UM Nurse functions as a member of the clinical service line team facilitates optimal reimbursement through accurate certification of their assigned patients. This position conducts initial admission reviews and refers cases for secondary review when appropriate. This role ensures the adherence to regulatory requirements with Medicare, FFS Medicaid, and other government payers. The UM Nurse refers and consults with the multidisciplinary team to promote appropriate communication of the review results to hospital revenue professionals to ensure proper utilization of hospital resources for accurate reimbursement.
Entity
Medical University Hospital Authority (MUHA)
Worker Type
Employee
Worker Sub-Type
Regular
Cost Center
CC005339 SYS - Utilization Management
Pay Rate Type
Salary
Pay Grade
Health-28
Scheduled Weekly Hours
40
Work Shift
Job Description
Hours per week: 40
Scheduled Work Hours/Shift: Days
Fair Labor Standards Act Status: Salaried
Job Summary/Purpose: Conducts utilization reviews to determine if patients are receiving care appropriate to severity of illness or condition and intensity of services required. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Consults with providers and other stakeholders as needed.
Minimum Training and Education: Bachelor's degree in Nursing from an accredited school of nursing and five years of nursing work experience to include two years utilization / case management experience in a hospital setting required. Prior leadership experience preferred. Evidence of committee involvement within a healthcare setting needed (either departmental or hospital-wide). Must possess excellent verbal and written communication skills. Familiarity with InterQual and/or MCG screening criteria desired.
Required Licensure, Certifications, Registrations: Licensure as a registered nurse by the state of South Carolina or compact state required.
Physical Requirements:
(C)ontinuous = 6-8 hours per shift; (F)requent = 2-6 hours per shift; (I)nfrequent = 0-2 hours per shift) Ability to perform job junctions while standing (C), while sitting (I), while walking (F). Ability to climb stairs (I); work indoors (C); work from elevated areas (I); work in confined/cramped spaces (I); perform job functions from kneeling positions (I); bend at the waist (F); twist at the waist (F); squat and perform job functions(I); perform ‘pinching’ operations (I); and fully use both hands/arms (C). Ability to perform repetitive motions with hands/wrists/elbows and shoulders (F), ability to fully use both legs (C), to reach in all directions, possess good finger dexterity (C), maintain tactile sensory functions (C) and maintain good olfactory sensory function (C). Ability to lift and carry up to 50 lbs, unassisted and lift/carry patients up to 350 lbs (+/-), assisted. Ability to lift objects from floor level to height of 36 inches, up to 50 lbs, unassisted. Ability to lower objects, to 50 lbs, from height of 36 inches, unassisted. Ability to push/pull objects up to 350 lbs (+/-), unassisted. Maintain 20/40 vision, corrected. (C), see and recognize objects close at hand (C) and objects at a distance (C). Ability to match or discriminate between colors (C), to determine distance/relationship between objects; depth perception. (C) and good peripheral vision capabilities (C). Ability to maintain hearing acuity, with correction (C), ability to hear and understand whispered conversations at a distance of three feet, must be ambidextrous. Ability to perform gross motor functions with frequent fine motor movements (C). Ability to be qualified physically (by medical personnel) for respirator use, initially and annually. Ability to deal effectively with stressful situations. Computer literacy, ability to work rotating shifts, provide extended leadership coverage as needed, ability to learn and use new processes, tools equipment as required.
If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees
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Get Access To All JobsTips for Finding Visa Sponsorship as an Utilization Management Nurse
Confirm your RN license transfers
U.S. employers require an active state RN license or a Visa Screen certificate before sponsorship begins. Apply for NCLEX and state licensure early, this step alone can add months to your timeline if left until late.
Target large health systems and payers
National insurers and large hospital networks like Kaiser, UnitedHealth, and Cigna have established immigration programs. They sponsor more frequently than smaller regional employers and typically have in-house legal teams to manage the H-1B petition process.
Understand the specialty occupation argument
UM Nurse roles require a BSN or higher and apply clinical judgment to coverage decisions, this typically satisfies USCIS specialty occupation criteria. If your role is framed broadly, ask the employer to emphasize the clinical review component in the petition.
Get your credentials evaluated early
If you trained outside the U.S., a foreign credential evaluation from a NACES-approved body confirms your nursing degree meets U.S. equivalency standards. Employers and USCIS both rely on this document, and it can take six to eight weeks to obtain.
Ask about remote UM roles with sponsorship
Many utilization management positions are fully remote, which opens sponsorship opportunities with employers across all 50 states. Broader employer access significantly improves your odds of finding a company willing to file an H-1B or TN petition on your behalf.
Utilization Management Nurse jobs are hiring across the US. Find yours.
Find Utilization Management Nurse JobsFrequently Asked Questions
Do Utilization Management Nurse roles qualify as H-1B specialty occupations?
Yes, in most cases. USCIS evaluates whether the position normally requires a bachelor's degree or higher in a specific field. UM Nurse roles requiring a BSN and active RN licensure to perform clinical reviews and apply evidence-based criteria, such as InterQual or Milliman, consistently meet this threshold. Roles framed as administrative without clinical judgment components are less defensible, so job description language matters.
What degree and license do I need for an employer to sponsor me?
At minimum, you need a Bachelor of Science in Nursing and an active RN license in the state where you'll work, or a multi-state Compact license. Some employers also accept ADN-prepared nurses with extensive UM experience, but this weakens the specialty occupation argument for H-1B. A Visa Screen certificate from CGFNS is required if you trained outside the U.S. and are applying from abroad.
Are there visa options for UM Nurses besides the H-1B?
Yes. Canadian nurses can pursue TN status under the USMCA, which has no cap, no lottery, and can be approved the same day at a port of entry. Australian nurses may explore the E-3 visa. Nurses with extraordinary ability or significant research contributions may qualify for O-1A. EB-3 immigrant visas are also a common long-term pathway for nurses, with some employers sponsoring permanent residence directly.
Which employers are most likely to sponsor Utilization Management Nurses?
Large managed care organizations, national health insurers, and major hospital systems are the most active sponsors. Employers with existing immigration infrastructure are more willing to take on the cost and complexity of a petition. You can browse verified sponsoring employers actively hiring Utilization Management Nurses on Migrate Mate, which filters specifically for roles open to visa sponsorship.
Can I work as a Utilization Management Nurse remotely while on an H-1B?
Yes, but with an important caveat. H-1B workers must have a certified Labor Condition Application covering every location where work is performed. For remote roles, the LCA must list your home address or primary work location. If you move states, your employer needs to file an amended LCA before you start working from the new location. This is a common compliance issue in remote UM positions.
What is the prevailing wage requirement for sponsored Utilization Management Nurse jobs?
U.S. employers sponsoring a visa must pay at least the prevailing wage, which is what workers in the same role, area, and experience level typically earn. The Department of Labor sets this rate to make sure companies aren't hiring foreign workers simply because they'd accept lower pay than a U.S. worker. It varies by job title, location, and experience. You can look up current prevailing wage rates for any occupation and location using the OFLC Wage Search page.
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