ZipRecruiter

Log In

1

Aetna Prior Authorization Jobs (NOW HIRING)

A-Line Staffing Solutions

Be Seen First

LPN- Remote- Prior Authorization/Utilization Review

Orlando, FL · Remote

$37 - $38/hr

Prior CVS/Aetna work experience: No Verifyable High School Diploma or GED Required: Yes ALERT ... Provides support to the Prior Authorization Department in meeting client expectations regarding ...

Posted today

next page

Showing results 1-20

All JobsAetna Prior Authorization Jobs

Aetna Prior Authorization information

See salary details

$87K

$134.7K

$189K

How much do aetna prior authorization jobs pay per year?

As of Aug 28, 2026, the average yearly pay for aetna prior authorization in the United States is $134,701.00, according to ZipRecruiter salary data. Most workers in this role earn between $104,000.00 and $163,500.00 per year, depending on experience, location, and employer.

What is an Aetna Prior Authorization?

An Aetna Prior Authorization job involves reviewing and processing requests for medical services, medications, or procedures to determine if they meet Aetna’s coverage guidelines. Employees in this role assess medical necessity, ensure compliance with policy criteria, and communicate decisions to providers and members. They may collaborate with healthcare professionals and use clinical guidelines to make determinations. Strong attention to detail and knowledge of insurance policies are essential in this role.

What skills and qualifications are needed for an Aetna Prior Authorization?

To thrive as an Aetna Prior Authorization specialist, you need a thorough understanding of medical terminology, insurance guidelines, and healthcare administrative processes, often acquired through healthcare experience or relevant certification. Familiarity with authorization software systems, electronic health records (EHR), and insurer portals is highly valued. Attention to detail, strong organizational skills, and effective communication are crucial for coordinating between providers, patients, and insurance representatives. These skills help ensure timely and accurate approval of medical services, reducing delays and supporting positive patient outcomes.

What are common challenges faced by Aetna Prior Authorization specialists, and how are they addressed?

Aetna Prior Authorization specialists often encounter challenges such as navigating evolving insurance requirements, managing large caseloads, and clarifying complex medical necessity criteria with providers. To address these, they rely on comprehensive training, stay updated on policy changes, and use detailed checklists and software tools to track case status and documents. Collaboration with clinical staff and insurance representatives is key to overcoming authorization barriers efficiently. A supportive team environment and ongoing professional development also help specialists stay effective and maintain accuracy in this fast-paced role.

More about Aetna Prior Authorization jobs

What cities are hiring for Aetna Prior Authorization jobs?

Cities with the most Aetna Prior Authorization job openings:

What are the most commonly searched types of Aetna Prior Authorization jobs?

The most popular types of Aetna Prior Authorization jobs are:

What states have the most Aetna Prior Authorization jobs?

States with the most job openings for Aetna Prior Authorization jobs include:

What job categories do people searching Aetna Prior Authorization jobs look for?

The top searched job categories for Aetna Prior Authorization jobs are:

Aetna Prior Authorization jobs near you
Infographic showing various Aetna Prior Authorization job openings in the United States as of August 2026, with employment types broken down into 97% Full Time, and 3% Part Time. Highlights an 76% In-person, and 24% Remote job distribution, with an average salary of $134,701 per year, or $64.8 per hour.

RPh Operations Advisor - Aetna Medical Prior Authorizations

CVS Health

Remote

$50.48 - $84.62/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 9 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,352 frontline employees who took The Breakroom Quiz

90th of 113 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary
Are you ready to take your clinical skills to the next level? Check out this outstanding opportunity for a Clinical Pharmacist with the Specialty Medical Prior Authorization team!
The Clinical Pharmacist is an operations based role that conducts reviews of medical data collected to perform prior authorization review for specialty medications. The Clinical Pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases. This role will work from CVS Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations.
Operational hours are 8am-7pm CT, and we are seeking a candidate who is able to work 8am-7pm CT. Rotating weekends and occasional holidays may be required per business needs. The position is fully remote.
Required Qualifications
- Active pharmacist license in state of residence in good standing
- 2+ years clinical pharmacist experience
- 1+ years demonstrated experience issuing clinical determinations within Prior Authorizations
- Current experience working within the Novologix system, specifically Aetna Medical Prior Authorization Operations
- Current experience issuing clinical determinations within Aetna Medical PA


Preferred Qualifications
Excellent interpersonal skills
Demonstrate problem solving ability and attention to detail
Ability to work effectively in a team environment with great dependability
Excellent oral and written communication skills
Ability to quickly assess and adapt to constantly changing situations
Required to possess a high mental agility and alertness
Ability to effectively communicate with pharmacists, other clinical colleagues, healthcare professionals, and members
Ability to effectively prioritize work while exhibiting a high level of urgency with all calls and assignments
Follows all prior authorization procedures to ensure a timely and accurate process on each prior authorization
Ability to effectively train and mentor representatives on the PA team
Call center, PBM, or clinical experience
Strong Microsoft Office skills
Experience utilizing CAS, Novologix, Sales Force, RxClaim, and PeopleSafe.


Education
Bachelor of Pharmacy or PharmD

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$50.48 - $84.62

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/23/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

What CVS Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply