Utilization Management Specialist Jobs in USA with Visa Sponsorship
Utilization Management Specialists review medical necessity and coordinate care approvals for health plans and hospital systems, roles that routinely sponsor H-1B visas for candidates with clinical or health informatics backgrounds. Most positions require at least a bachelor's degree in nursing, health administration, or a related field. For detailed occupation requirements, see the O*NET profile.
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Get Access To All JobsPosition Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.
- Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
- Collaborates with utilization management team to resolve complex care member issues
- Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
- Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
- Educates and provides resources for utilization management team on key initiatives and to facilitate ongoing communication between utilization management team, members, and providers
- Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures
- Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
- Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones
- Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards
- Assists with onboarding, hiring, and training utilization management team members
- Leads and champions change within scope of responsibility
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience. Knowledge of utilization management principles preferred.
License/Certification:
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
- CA RN Licensure required
Pay Range: $75,300.00 - $135,400.00 per year
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.
- Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
- Collaborates with utilization management team to resolve complex care member issues
- Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
- Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
- Educates and provides resources for utilization management team on key initiatives and to facilitate ongoing communication between utilization management team, members, and providers
- Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures
- Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
- Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones
- Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards
- Assists with onboarding, hiring, and training utilization management team members
- Leads and champions change within scope of responsibility
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience. Knowledge of utilization management principles preferred.
License/Certification:
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
- CA RN Licensure required
Pay Range: $75,300.00 - $135,400.00 per year
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
See all 4,582+ Utilization Management Specialist Jobs
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Get Access To All JobsTips for Finding Visa Sponsorship as an Utilization Management Specialist
Target managed care organizations and large hospital networks
Large health plans like Cigna, Aetna, and Kaiser Permanente, along with major hospital systems, file H-1B petitions for UM Specialists regularly. These employers have established immigration processes and dedicated HR teams familiar with sponsorship paperwork.
Confirm your degree aligns with the specialty occupation standard
USCIS requires a specific bachelor's degree field tied to the role. Nursing, health information management, public health, or healthcare administration degrees typically satisfy this. A general business or unrelated science degree may complicate your H-1B petition.
Clinical licensure strengthens your sponsorship case
Holding an RN license or case management certification like CCM signals specialized knowledge that supports the specialty occupation argument. Employers offering sponsorship often prioritize credentialed candidates because the petition is easier for their immigration attorneys to build.
Remote UM roles can complicate LCA compliance
If you work remotely, your employer must file a Labor Condition Application covering the prevailing wage for your actual work location, not the company's headquarters. Clarify your work arrangement early so your employer understands the LCA requirements before filing.
Ask about sponsorship before the final interview round
UM roles attract competitive candidate pools. Raising sponsorship needs early saves time for both sides. Frame it factually: you require H-1B sponsorship to continue working in the U.S. after your current authorization expires. Most large employers have a standard answer ready.
Use Migrate Mate to find pre-screened sponsoring employers
Migrate Mate filters job listings to surface employers with verified H-1B sponsorship histories in healthcare and UM specifically. Browsing there saves significant time compared to applying broadly and discovering sponsorship limitations late in the process.
Frequently Asked Questions
Do Utilization Management Specialist roles qualify for H-1B sponsorship?
Yes, UM Specialist positions generally qualify as H-1B specialty occupations when the role requires a specific bachelor's degree in nursing, health administration, health information management, or a closely related clinical field. Employers must demonstrate the degree requirement is genuine and tied to the actual job duties, not just listed as a preference.
What degree do I need for a sponsored Utilization Management Specialist job?
Most employers require a bachelor's degree in nursing, healthcare administration, public health, or health information management. Some positions accept a clinical degree plus relevant certifications such as CCM or CPHM. A general business degree without a healthcare specialization may not satisfy USCIS's specialty occupation standard for this role.
Can I work as a Utilization Management Specialist on an OPT or STEM OPT extension?
Yes, if your degree is in a qualifying field. Standard OPT gives you 12 months of work authorization post-graduation. If your degree is in a STEM-designated program, such as health informatics or biomedical informatics, you may qualify for a 24-month STEM OPT extension, giving you more time before needing H-1B sponsorship.
Which types of employers are most likely to sponsor H-1B visas for UM Specialists?
Managed care organizations, large integrated health systems, and government-contracted Medicaid managed care plans are the most consistent H-1B sponsors for UM roles. Smaller physician groups or independent utilization review organizations file far fewer petitions and may lack the infrastructure to manage sponsorship. Browse Migrate Mate to find employers with confirmed H-1B sponsorship histories in this specialty.
Does an RN license improve my chances of getting sponsored for a UM role?
It does, meaningfully. An active RN license demonstrates the specialized clinical knowledge that supports the specialty occupation argument under USCIS guidelines. Many UM Specialist job descriptions list RN licensure as required or strongly preferred, and immigration attorneys find these petitions easier to document. Case management certifications like the CCM carry similar weight.
What is the prevailing wage requirement for sponsored Utilization Management Specialist 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.