ZipRecruiter

Log In

1

Aetna Utilization Management Jobs (NOW HIRING)

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 ...

Amylyx Pharmaceuticals

CVS Health - Aetna/CVS Caremark/Zinc * Elevance Health - Anthem/CarelonRx * Assigned national and ... Develop payer coverage and utilization-management strategy recommendations that support compliant ...

Managed Staffing

Case Management Coordinator

TX · Remote

$29 - $30/hr

... support our Aetna Care Management team. This is a non-clinical, telephonic, fully remote role ... Promote improved health outcomes and assist in reducing unnecessary healthcare utilization.

CVS Health

Case Manager, Registered Nurse

$54K - $155K/yr

... Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost ...

CVS Health

Case Manager, Registered Nurse

Home, KS · On-site

$54K - $155K/yr

... Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost ...

CVS Health

Case Manager, Registered Nurse

Homer, AK · Remote

$54K - $155K/yr

... Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost ...

previous page

Showing results 41-60

All JobsAetna Utilization Management Jobs

Aetna Utilization Management information

See salary details

$39K

$89.5K

$163K

How much do aetna utilization management jobs pay per year?

As of Aug 10, 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.

Technical Test Lead | Healthcare | Provider Network Management

Spruce Infotech

Hartford, CT • On-site

Full-time

Re-posted 13 days ago

Job description

Job Title: QE Lead (Enterprise Transformation Testing - Broadcom Exit Program)
Work Location: HartfordCT6156
XXX
Contract duration: 12
Target Start Date: 01 Jul 2026
Does this position require Visa independent candidates only? YES
**hybrid work set-up**
Job Details:
Must Have Skills
QA Strategy & Transformation (Broadcom → IBM migration)
Data migration validation (reconciliation & regression)
Sampling-based validation for large datasets
Automation-led validation approaches
SQL / data validation techniques
Nice to have skills
Clinical Adjudication (CAM)
Medical necessity review processes
Authorization workflows
Clinical policy validation
Payer decision frameworks
Detailed Job Description
• Possesses strong experience in Clinical Adjudication (CAM), supporting medical necessity reviews, authorization workflows, and clinical policy validations, with solid alignment to payer decision frameworks.
• Demonstrates strong understanding of utilization management and coding guidelines, enabling effective collaboration with clinical and business stakeholders.
• Lead QA strategy for large-scale platform transformation (Broadcom → IBM stack), ensuring seamless transition across systems.
• Strong expertise in data migration validation, including before/after reconciliation and comprehensive regression coverage.
• Hands-on experience with sampling-based validation approaches for large enterprise datasets and systems.
• Proficient in automation-led validation, leveraging SQL/data checks and RPA/UI tools (e.g., UiPath) to drive efficiency.
• Ability to define QA operating model, team structure, and delivery roadmap (8-15 resources) aligned to program goals.
• Extensive exposure to enterprise-scale programs with multi-system dependencies (online, batch, and data migration ecosystems).
Minimum years of experience
8-10 years
Certifications Needed :No
Top 3 responsibilities you would expect the Subcon to shoulder and execute
Stakeholder Managment IT and Business
Test Managment and defect Management
Test Reporting and SLAs
Interview Process (Is face to face required?)
Yes
Any additional information you would like to share about the project specs/ nature of work
support critical Caremark Aetna initiatives across claims and provider domains, including largescale enterprise transformation and core QA delivery. These roles are pivotal to ensuring release stability, regression coverage, and transformation readiness, with strong dependency on onsite coordination and leadership presence.
Project Code: Hartford Child code for HC 1 2 7 and SS

Apply