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 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: Remote ND (Central Time)
Location: Remote, ND
Address:
Shift: Day
Job Schedule: Full time
Weekly Hours: 40.00
Salary Range: $27.50 - $38.50
Department Details
Opportunity to work remote.
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 Health 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 Health 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-0252699
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: Remote ND (Central Time)
Location: Remote, ND
Address:
Shift: Day
Job Schedule: Full time
Weekly Hours: 40.00
Salary Range: $27.50 - $38.50
Department Details
Opportunity to work remote.
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 Health 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 Health 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-0252699
Job Function: Care Coordination
Featured: No
How to Get 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.
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Get Access To All JobsFrequently 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.
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