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 JobsJob ID 21606
Location Los Angeles, California, United States
Job Category Patient Services
Date posted 10/23/2026
Job Description
Align yourself with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 times for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company’s Workplace of the Year. This annual award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. We offer an outstanding benefits package that includes health care, paid time off, and a 403(B). Join us! Discover why U.S. News & World Report has named us one of America’s Best Hospitals.
What You Will Do in This Role:
The Utilization Management Specialist provides advanced operational and workflow support to Utilization Review (UR) Nurses to ensure timely, accurate, and compliant execution of the utilization review process. This position performs complex, non-clinical functions that directly support payer communication, authorization coordination, documentation integrity, and regulatory compliance.
The Utilization Management Specialist maintains an assigned portfolio of cases in partnership with multiple UR Nurses and is accountable for oversight of authorization workflows from initial submission, follow-up through to final determination. The role applies independent judgment in prioritizing cases based on payer deadlines, regulatory requirements, and authorization expiration risk.
In collaboration with UR Nurses, Case Management, Revenue Cycle, and external payers, the Utilization Management Specialist ensures documentation and authorization activities are complete, accurate, and executed within established timeframes. This position plays a critical role in supporting revenue integrity, denial prevention, and compliance with CMS and payer specific requirements.
The role operates in a fast-paced, time-sensitive environment using EPIC/CS-Link, AIDIN, payer portals, and related UM systems to proactively manage workflows and remove administrative barriers that could delay review completion or payer communication.
- Maintain an assigned portfolio of cases in partnership with UR Nurses to support timely utilization review activities.
- Prepare and assemble clinical review packets and supporting documentation for payer submission.
- Review records to confirm required documentation elements are present prior to submission and escalate gaps to the assigned UR Nurse.
- Track submission confirmations and ensure timely follow up on pending payer determinations.
- Manage the authorization lifecycle for assigned cases, including entry, tracking, follow up, documentation of determinations, and monitoring of payer response timelines.
- Monitor payer portals and contact payers directly, as needed, to obtain authorization updates and resolve status discrepancies.
- Independently prioritize cases based on submission deadlines, authorization expiration risk, and regulatory timeframes.
- Escalate urgent authorization issues, delays, or barriers that may result in avoidable denials or authorization lapses.
- Coordinate peer to peer scheduling logistics and maintain related documentation.
- Document and communicate payer determinations, including approvals, partial approvals, and denials, in EPIC/CS-Link in accordance with departmental and regulatory standards.
- Identify patterns or systemic authorization workflow issues and communicate trends to UM leadership.
- Document and communicate payer determinations, including approvals, partial approvals, and denials.
- Ensure all required documentation is accurately entered into EPIC/CS-Link in accordance with departmental and regulatory standards.
- Communicate effectively with internal and external partners to ensure patient and authorization information is current and complete.
Approved Remote States: Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas
Qualifications
Requirements
- High school diploma or GED required. Associate's degree or college diploma in business or health or a related field preferred.
- Minimum of 2 years of experience in hospital authorization management, utilization review support, revenue cycle operations, or payer communication processes required.
- Experience independently managing authorization workflows highly preferred.
- Minimum of 2 years of acute care experience preferred.
Why work here?
Beyond outstanding benefits, competitive salaries and health and dental insurance We take pride in hiring the best employees. Our amazing staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.
Req ID 21606
Working Title Utilization Management Specialist (Remote)
Department Utilization Management
Business Entity Cedars-Sinai Medical Center
Job Category Patient Services
Job Specialty Case Management
Overtime Status NONEXEMPT
Primary Shift Day
Shift Duration 8 hour
Base Pay $25.57 - $39.63
Diversity and Inclusion at Cedars-Sinai
We are caretakers and innovators committed to the pursuit of equitable healthcare. But health equity is not possible without representation. Our commitment to diversity goes beyond demographics or checking boxes. Our people must reflect the diverse identities, experiences and geographies of the communities and patients we serve – because that’s what our patients, colleagues and communities deserve Quality Care and Research—For All, By All.
Our compensation philosophy
We offer a competitive compensation package for our employees. The base pay range shown generally applies to the greater Los Angeles area and may vary based on work location. Our range takes into account the wide range of factors that are considered in making compensation decisions, including knowledge/skills: relevant experience and training, education/certifications/licensure; and other business and organizational factors. The base pay range does not include any incentive payments that may be applicable to a role. Pay Transparency Non-Discrimination Provision (PDF).
Cedars-Sinai is an Equal Employment Opportunity employer.
Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.
Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy.
Job ID 21606
Location Los Angeles, California, United States
Job Category Patient Services
Date posted 10/23/2026
Job Description
Align yourself with an organization that has a reputation for excellence! Cedars-Sinai was awarded the National Research Corporation’s Consumer Choice Award 19 times for providing the highest-quality medical care in Los Angeles. We also were awarded the Advisory Board Company’s Workplace of the Year. This annual award recognizes hospitals and health systems nationwide that have outstanding levels of employee engagement. We offer an outstanding benefits package that includes health care, paid time off, and a 403(B). Join us! Discover why U.S. News & World Report has named us one of America’s Best Hospitals.
What You Will Do in This Role:
The Utilization Management Specialist provides advanced operational and workflow support to Utilization Review (UR) Nurses to ensure timely, accurate, and compliant execution of the utilization review process. This position performs complex, non-clinical functions that directly support payer communication, authorization coordination, documentation integrity, and regulatory compliance.
The Utilization Management Specialist maintains an assigned portfolio of cases in partnership with multiple UR Nurses and is accountable for oversight of authorization workflows from initial submission, follow-up through to final determination. The role applies independent judgment in prioritizing cases based on payer deadlines, regulatory requirements, and authorization expiration risk.
In collaboration with UR Nurses, Case Management, Revenue Cycle, and external payers, the Utilization Management Specialist ensures documentation and authorization activities are complete, accurate, and executed within established timeframes. This position plays a critical role in supporting revenue integrity, denial prevention, and compliance with CMS and payer specific requirements.
The role operates in a fast-paced, time-sensitive environment using EPIC/CS-Link, AIDIN, payer portals, and related UM systems to proactively manage workflows and remove administrative barriers that could delay review completion or payer communication.
- Maintain an assigned portfolio of cases in partnership with UR Nurses to support timely utilization review activities.
- Prepare and assemble clinical review packets and supporting documentation for payer submission.
- Review records to confirm required documentation elements are present prior to submission and escalate gaps to the assigned UR Nurse.
- Track submission confirmations and ensure timely follow up on pending payer determinations.
- Manage the authorization lifecycle for assigned cases, including entry, tracking, follow up, documentation of determinations, and monitoring of payer response timelines.
- Monitor payer portals and contact payers directly, as needed, to obtain authorization updates and resolve status discrepancies.
- Independently prioritize cases based on submission deadlines, authorization expiration risk, and regulatory timeframes.
- Escalate urgent authorization issues, delays, or barriers that may result in avoidable denials or authorization lapses.
- Coordinate peer to peer scheduling logistics and maintain related documentation.
- Document and communicate payer determinations, including approvals, partial approvals, and denials, in EPIC/CS-Link in accordance with departmental and regulatory standards.
- Identify patterns or systemic authorization workflow issues and communicate trends to UM leadership.
- Document and communicate payer determinations, including approvals, partial approvals, and denials.
- Ensure all required documentation is accurately entered into EPIC/CS-Link in accordance with departmental and regulatory standards.
- Communicate effectively with internal and external partners to ensure patient and authorization information is current and complete.
Approved Remote States: Arizona, California, Colorado, Florida, Georgia, Minnesota, Nevada, Oregon, Texas
Qualifications
Requirements
- High school diploma or GED required. Associate's degree or college diploma in business or health or a related field preferred.
- Minimum of 2 years of experience in hospital authorization management, utilization review support, revenue cycle operations, or payer communication processes required.
- Experience independently managing authorization workflows highly preferred.
- Minimum of 2 years of acute care experience preferred.
Why work here?
Beyond outstanding benefits, competitive salaries and health and dental insurance We take pride in hiring the best employees. Our amazing staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.
Req ID 21606
Working Title Utilization Management Specialist (Remote)
Department Utilization Management
Business Entity Cedars-Sinai Medical Center
Job Category Patient Services
Job Specialty Case Management
Overtime Status NONEXEMPT
Primary Shift Day
Shift Duration 8 hour
Base Pay $25.57 - $39.63
Diversity and Inclusion at Cedars-Sinai
We are caretakers and innovators committed to the pursuit of equitable healthcare. But health equity is not possible without representation. Our commitment to diversity goes beyond demographics or checking boxes. Our people must reflect the diverse identities, experiences and geographies of the communities and patients we serve – because that’s what our patients, colleagues and communities deserve Quality Care and Research—For All, By All.
Our compensation philosophy
We offer a competitive compensation package for our employees. The base pay range shown generally applies to the greater Los Angeles area and may vary based on work location. Our range takes into account the wide range of factors that are considered in making compensation decisions, including knowledge/skills: relevant experience and training, education/certifications/licensure; and other business and organizational factors. The base pay range does not include any incentive payments that may be applicable to a role. Pay Transparency Non-Discrimination Provision (PDF).
Cedars-Sinai is an Equal Employment Opportunity employer.
Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. If you need a reasonable accommodation for any part of the employment process, please contact us by email at Applicant_Accommodation@cshs.org and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.
Cedars-Sinai will consider for employment qualified applicants with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring.
At Cedars-Sinai, we are dedicated to the safety, health and wellbeing of our patients and employees. This includes protecting our patients from communicable diseases, such as influenza (flu). For this reason, we require that all new employees receive a flu vaccine based on the seasonal availability of flu vaccine (typically during September through April each year) as a condition of employment, and annually thereafter as a condition of continued employment, subject to medical exemption or religious accommodation. For the same reason, you may also be required to receive other vaccines as a condition of employment. Cedars-Sinai reserves the right to make modifications to its required list of vaccines as required by law and/or policy.
See all 4,031+ 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.