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Aetna Utilization Management Jobs (NOW HIRING)

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 ...

CVS Health

Lead Director - Clinical Innovation

$81K - $111K/yr

... Utilization Management (UM) automation strategy within Aetna's Clinical Solutions business unit. This role serves as a trusted advisor to senior leadership by identifying opportunities to improve ...

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 ...

Oak St. Health

A1A Precertification Nurse

$31.75 - $40.75/hr

... Aetna programs and plans. * Reviews for plan nuances and requirements including (institute of ... Drives effective utilization management practices by ensuring appropriate and cost-effective ...

CVS Health

Medical Director - ENT

$250K/yr

S. At Aetna, a CVS Health company , we're helping transform healthcare by making it more ... Conduct utilization management and medical necessity reviews. * Support timely and consistent ...

Oak St. Health

A1A Precertification Nurse

$31.75 - $40.75/hr

... Aetna programs and plans. * Reviews for plan nuances and requirements including (institute of ... Drives effective utilization management practices by ensuring appropriate and cost-effective ...

Oak St. Health

A1A Precertification Nurse

$31.75 - $40.75/hr

... Aetna programs and plans. * Reviews for plan nuances and requirements including (institute of ... Drives effective utilization management practices by ensuring appropriate and cost-effective ...

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 ...

CVS Health

Medical Director-Medicaid (ABH VA)

$174K - $374K/yr

Aetna operates Medicaid managed care plans in Arizona, Florida, Illinois, Kentucky, Louisiana ... Utilization Management and medical necessity reviews * Prior authorization and precertification ...

Human Resources

Utilization Review Coordinator

Aurora, CO · On-site

$64K/yr

Reporting to the Director of Utilization Review with a dotted-line relationship to the Director of ... Aetna, Cigna, Anthem/Elevance, Colorado Access, state Medicaid programs, and Medicaid managed care ...

Cytogenx

Be Seen First

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 ...

Varite

Healthcare Consultant II - Kansas

Atchison, KS · On-site

... Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. Utilizes critical ...

CVS Health

Medical Director - Medicare Appeals

$174K - $374K/yr

Position Summary Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest ... IRE monitoring and tracking and Utilization Management Strategy support * Collaborative work with ...

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Aetna Utilization Management information

See salary details

$39K

$89.5K

$163K

How much do aetna utilization management jobs pay per year?

As of Sep 1, 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 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.

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 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.

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 to become a utilization management professional?

To become a utilization management professional, typically one needs a bachelor's degree in healthcare, nursing, or a related field, along with experience in clinical or healthcare administration. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or Certified Utilization Review Professional (CURP) can enhance job prospects. Strong analytical skills, knowledge of medical policies, and familiarity with healthcare management systems are also important.
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, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.

Senior Manager, Financial Planning and Analysis Aetna Clinical Services (Utilization Management)

CVS Health

Scottsdale, AZ • On-site

$75K - $182K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 12 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,359 frontline employees who took The Breakroom Quiz

92nd 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
The Senior Manager will lead a team supporting the Utilization Management function within Clinical Services. Responsibilities will include FP&A functions (Budgeting & Forecasting, Expense Management, Month Close & Reporting), Operations support (membership-based and metrics driven staffing models), and managing business partnerships. Proficiency with Microsoft Excel and PowerPoint is needed along with experience with Aetna Finance systems and processes.


Fundamental Components:

  • Develops and executes the annual financial planning and analysis (FP&A) budgeting process, working closely with key stakeholders to establish financial targets and allocate resources effectively.

  • Oversees the analysis of financial performance, including variance analysis, trend analysis, and profitability analysis by providing insights and recommendations to senior leadership based on financial data and trends.

  • Conducts scenario analysis and sensitivity analysis to evaluate the financial impact of various business scenarios and help guide strategic decisions.

  • Creates sophisticated financial models to support strategic decision-making and long-term financial planning.

  • Analyzes the financial performance of business units, product lines, or projects, identifying areas of improvement and growth opportunities.

  • Establishes financial planning and analysis processes, systems, and tools to increase efficiency and accuracy.

  • Creates budgeting and forecasting processes, ensuring accuracy and alignment with strategic objectives.

  • Conducts performance evaluations, sets performance goals, provides guidance, and fosters a collaborative and high-performing team environment.

Required Qualifications:

  • 7+ years of relevant financial planning and analysis experience.

  • 7+ years of experience with Microsoft Excel and PowerPoint are needed along with experience with financial systems.

Preferred Qualifications:

  • Proficiency with Anaplan, Hyperion, and S4 Hana.

  • Healthcare, managed care, or financial services experience.

  • Advanced degree in finance, accounting, or related field.

Education:

  • Bachelor's Degree in finance, accounting, or related field required or equivalent years of relevant experience.

Pay Range

The typical pay range for this role is:

$75,400.00 - $182,549.00


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.

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: 09/28/2026

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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