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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The Utilization Management Behavioral Health Professional utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Key Responsibilities:
Clinical Review:
- Conduct comprehensive clinical reviews of prior authorization requests for behavioral health services to determine medical necessity.
- Apply advanced evidence-based clinical guidelines in review decisions.
- Ensure compliance with accreditation, state, and federal regulations.
Communication and Coordination:
- Communicate with healthcare providers to obtain necessary clinical information and clarify requests.
- Coordinate with medical directors and interdisciplinary teams to support decision-making.
- Serve as a liaison between clinicians, internal departments, and providers.
Documentation and Reporting:
- Document all review findings and decisions in the clinical documentation system.
- Ensure timely and accurate documentation of prior authorization determinations.
- Support reporting initiatives and provide data for performance improvement projects.
Quality Assurance:
- Implement quality assurance measures to ensure accuracy and consistency in prior authorization decisions.
- Participate in and review audit findings to maintain high standards of service.
- Identify process improvement opportunities and contribute to performance improvement projects.
Education and Training:
- Educate providers and staff on prior authorization policies, criteria, and review processes.
- Provide mentorship and feedback to nonclinical staff to enhance workflow efficiency.
- Stay current with clinical best practices and regulatory changes.
Use your skills to make an impact
Required Qualifications
Candidate must be one of the following:
- Licensed Masters Clinical Social Worker (LCSW)
- Licensed Masters Social Worker (LMSW-ACP)
- Licensed Professional Counselor (LPC)
- Psychologist (PhD)
- Registered Nurse, licensed in IL, with 3 years of BH experience
Candidate must also have 1+ year of post-degree clinical experience in private practice or other patient care.
Preferred Qualifications
- Experience with utilization review
- Experience with behavioral change, health promotion, coaching and wellness
- Certification in Case Management (CCM)
- Experience with Medicaid and Medicare policies and procedures
- Experience working with the older adult population
- Knowledge of payer policies, insurance companies and government health programs
- Knowledge of community health and social service agencies and additional community resources
- Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Become a part of our caring community
The Utilization Management Behavioral Health Professional utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Key Responsibilities:
Clinical Review:
- Conduct comprehensive clinical reviews of prior authorization requests for behavioral health services to determine medical necessity.
- Apply advanced evidence-based clinical guidelines in review decisions.
- Ensure compliance with accreditation, state, and federal regulations.
Communication and Coordination:
- Communicate with healthcare providers to obtain necessary clinical information and clarify requests.
- Coordinate with medical directors and interdisciplinary teams to support decision-making.
- Serve as a liaison between clinicians, internal departments, and providers.
Documentation and Reporting:
- Document all review findings and decisions in the clinical documentation system.
- Ensure timely and accurate documentation of prior authorization determinations.
- Support reporting initiatives and provide data for performance improvement projects.
Quality Assurance:
- Implement quality assurance measures to ensure accuracy and consistency in prior authorization decisions.
- Participate in and review audit findings to maintain high standards of service.
- Identify process improvement opportunities and contribute to performance improvement projects.
Education and Training:
- Educate providers and staff on prior authorization policies, criteria, and review processes.
- Provide mentorship and feedback to nonclinical staff to enhance workflow efficiency.
- Stay current with clinical best practices and regulatory changes.
Use your skills to make an impact
Required Qualifications
Candidate must be one of the following:
- Licensed Masters Clinical Social Worker (LCSW)
- Licensed Masters Social Worker (LMSW-ACP)
- Licensed Professional Counselor (LPC)
- Psychologist (PhD)
- Registered Nurse, licensed in IL, with 3 years of BH experience
Candidate must also have 1+ year of post-degree clinical experience in private practice or other patient care.
Preferred Qualifications
- Experience with utilization review
- Experience with behavioral change, health promotion, coaching and wellness
- Certification in Case Management (CCM)
- Experience with Medicaid and Medicare policies and procedures
- Experience working with the older adult population
- Knowledge of payer policies, insurance companies and government health programs
- Knowledge of community health and social service agencies and additional community resources
- Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
See all 4,435+ Utilization Management Specialist Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new Utilization Management Specialist roles.
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.