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Aetna Utilization Management Jobs (NOW HIRING)

Aetna

Case Manager RN

Charlottesville, VA · On-site

Company Description Aetna is about more than just doing a job. This is our opportunity to re-shape ... Previous experience conducting face-to-face care management is a plus; qualified candidates must ...

Aetna

Case Manager RN

Charlottesville, VA · Remote

Company Description Aetna is about more than just doing a job. This is our opportunity to re-shape ... Previous experience conducting face-to-face care management is a plus; qualified candidates must ...

Varite

Registered Nurse

Staff may be required to contact the providers of record, vendors, or internal Aetna departments to ... MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. * MUST HAVE 6 ...

US Tech Solutions

Registered Nurse

Wichita, KS · On-site

Staff may be required to contact the providers of record, vendors, or internal Aetna departments to ... MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. * MUST HAVE 6 ...

Cytogenx

Medical Billing Specialist

Stony Brook, NY · On-site

$19.75 - $25.50/hr

Aetna * Cigna * Blue Cross Blue Shield * Healthfirst * Other commercial payers * Familiarity with prior authorization and utilization management processes. * Strong analytical, organizational, and ...

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All JobsAetna Utilization Management Jobs

Aetna Utilization Management information

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$39K

$89.5K

$163K

How much do aetna utilization management jobs pay per year?

As of Aug 11, 2026, the average yearly pay for aetna utilization management in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

What is the difference between Aetna Utilization Management vs Aetna Case Management?

AspectAetna Utilization ManagementAetna Case Management
Primary FocusReviewing medical necessity of services and proceduresCoordinating ongoing patient care and support
Work EnvironmentUtilizes clinical guidelines to approve or deny servicesEngages with patients, providers, and care teams for case coordination
CredentialsRN, LPN, or other clinical certifications often requiredRN or social work credentials commonly needed

While both roles are integral to healthcare management at Aetna, Utilization Management primarily focuses on evaluating the necessity of medical services, whereas Case Management emphasizes ongoing patient support and care coordination. Understanding these differences helps clarify career paths and job expectations within the industry.

How does the Utilization Management team at Aetna collaborate with other departments to ensure quality patient care?

Aetna's Utilization Management (UM) professionals work closely with medical directors, case managers, and provider relations teams to review clinical information and make coverage determinations. This collaborative approach ensures that care decisions are evidence-based and compliant with regulatory guidelines, while also supporting members' unique health needs. UM staff often participate in interdisciplinary meetings and coordinate with external providers to resolve complex cases or expedite approvals, which helps maintain a high standard of patient care.

What is Aetna Utilization Management?

Aetna Utilization Management is a process used by Aetna, a major health insurance provider, to ensure that members receive appropriate, efficient, and cost-effective healthcare services. It involves reviewing requests for medical treatments, procedures, and hospital stays to determine if they meet established criteria for medical necessity. This process helps to manage healthcare costs while making sure patients get the care they need. Utilization management may include prior authorizations, concurrent reviews, and case management to coordinate care. The goal is to optimize health outcomes and use healthcare resources responsibly.

What are the key skills and qualifications needed to thrive as an Aetna Utilization Management nurse, and why are they important?

To thrive as an Aetna Utilization Management Nurse, you need a valid RN license, in-depth clinical knowledge, and experience in case management or utilization review. Familiarity with medical review software, health plan policies, and systems like InterQual or Milliman is typically required. Strong critical thinking, attention to detail, and effective communication skills are crucial for making objective decisions and collaborating with providers. These competencies ensure appropriate care utilization, regulatory compliance, and optimal outcomes for both patients and the organization.
More about Aetna Utilization Management jobs
What states have the most Aetna Utilization Management jobs? States with the most job openings for Aetna Utilization Management jobs include:
What job categories do people searching Aetna Utilization Management jobs look for? The top searched job categories for Aetna Utilization Management jobs are:
Aetna Utilization Management jobs near you
Infographic showing various Aetna Utilization Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.

Senior Data Scientist - Utilization Management

Hispanic Alliance for Career Enhancement

Wellesley, MA • On-site

$101.97 - $222.48/hr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 6 days ago

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 ourselves accountable 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

At CVS/Aetna, we're pioneering a total approach to health and wellness. As a Data Scientist on the Analytics & Behavior Change team, you'll build industry-leading analytics, data, and technology platforms to help reimagine health care. This position will play a critical role within a cross-functional team, delivering powerful solutions.

Utilization Management

UM ensures consistent delivery of the right care, in the right setting, by the right people. The UM Data Science team leverage data, analytics and AI solutions to transform UM operations and optimize provider and member experience.

Responsibilities
  • Collaborates with business partners to shape the analytics approach to address business priorities (through predictive modeling, statistical analysis, or metric evaluation) as a thought leader
  • Owns and manages an analytics workstream, leading other analysts and data scientists to build end to end analytical products.
  • Uses strong knowledge in algorithms and predictive models to propose approaches, investigate problems, detect patterns and recommend solutions
  • Performs analyses of structured and unstructured data to solve multiple and/or complex business problems utilizing advanced statistical techniques and mathematical analyses and broad knowledge of the organization and/or industry
  • Develops and participates in presentations and consultations to existing and prospective constituents on analytics results and solutions
  • Use strong programming skills to explore, examine and interpret large volumes of data in various forms
Required Qualifications
  • 3+ years of relevant analytic experience
  • Experience programming using R or Python
  • Experience in SQL
Preferred Qualifications
  • Demonstrates strong ability to communicate technical concepts and implications to business partners
  • Anticipates and prevents problems and roadblocks before they occur
  • Strong knowledge of advanced analytics tools and languages to analyze large data sets from multiple data sources
  • Demonstrates proficiency in most areas of mathematical analysis methods, machine learning, statistical analyses, and predictive modeling and in-depth specialization in some areas
  • Hand on experience with LLMs and Generative AI
Education
  • Bachelor's degree or equivalent work experience in Mathematics, Statistics, Computer Science, Business Analytics, Economics, Physics, Engineering, or related discipline.
  • Master's degree or PhD preferred
Pay Range

$101,970.00 - $222,480.00. The typical pay range for this role is:

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. This position also includes an award target in the company's equity award program.

Benefits

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 full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being 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: 08/31/2026

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

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