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Aetna Utilization Review Jobs (NOW HIRING)

Saint Francis Hospital

Staff Pharmacist

Memphis, TN · On-site

$53 - $62.50/hr

May also advise physicians on medication utilization. * Review and monitor patient's medication ... Aetna. Saint Francis Hospital serves as an academic training site for University of Tennessee ...

Saint Francis Hospital

Staff Pharmacist

Memphis, TN · On-site

$50.50 - $59.25/hr

May also advise physicians on medication utilization. * Review and monitor patient's medication ... Aetna. Saint Francis Hospital serves as an academic training site for University of Tennessee ...

Saint Francis Hospital

Staff Pharmacist

Memphis, TN · On-site

$51.75 - $61/hr

May also advise physicians on medication utilization. * Review and monitor patient's medication ... Aetna. Saint Francis Hospital serves as an academic training site for University of Tennessee ...

Saint Francis Hospital

Staff Pharmacist

Collierville, TN · On-site

$52.50 - $62/hr

May also advise physicians on medication utilization. * Review and monitor patient's medication ... Aetna. Saint Francis Hospital serves as an academic training site for University of Tennessee ...

Saint Francis Hospital

Staff Pharmacist

Memphis, TN · On-site

$53 - $62.50/hr

May also advise physicians on medication utilization. * Review and monitor patient's medication ... Aetna. Saint Francis Hospital serves as an academic training site for University of Tennessee ...

Saint Francis Hospital

Staff Pharmacist

Memphis, TN · On-site

$55.25 - $65/hr

May also advise physicians on medication utilization. * Review and monitor patient's medication ... Aetna. Saint Francis Hospital serves as an academic training site for University of Tennessee ...

Saint Francis Hospital

Staff Pharmacist

Memphis, TN · On-site

$59 - $69.50/hr

May also advise physicians on medication utilization. * Review and monitor patient's medication ... Aetna. Saint Francis Hospital serves as an academic training site for University of Tennessee ...

Saint Francis Hospital

Staff Pharmacist

Memphis, TN · On-site

$53 - $62.50/hr

May also advise physicians on medication utilization. * Review and monitor patient's medication ... Aetna. Saint Francis Hospital serves as an academic training site for University of Tennessee ...

Saint Francis Hospital

Staff Pharmacist

Cordova, TN · On-site

$51.50 - $60.50/hr

May also advise physicians on medication utilization. * Review and monitor patient's medication ... Aetna. Saint Francis Hospital serves as an academic training site for University of Tennessee ...

CVS Health

Case Manager, Registered Nurse

$54K - $155K/yr

American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

CVS Health

Case Manager, Registered Nurse

Home, KS · On-site

$54K - $155K/yr

American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

CVS Health

Case Manager, Registered Nurse

Homer, AK · Remote

$54K - $155K/yr

American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

CVS Health

Case Manager, Registered Nurse

New York, NY · Remote

$54K - $155K/yr

American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

CVS Health

MI · On-site

$54K - $155K/yr

American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

New

CVS Health

MI · On-site

$54K - $155K/yr

American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

CVS Health

Case Manager, Registered Nurse

Sanford, ME · On-site

$54K - $155K/yr

American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

New

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Aetna Utilization Review information

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How much do aetna utilization review jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for aetna utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What does an Aetna Utilization Review do?

A typical day for an Aetna Utilization Review professional involves reviewing medical records, applying established clinical criteria to determine the medical necessity of services, and collaborating with both healthcare providers and internal teams. You may participate in case discussions, coordinate with physicians, and document determinations in Aetna's systems. The role often involves balancing independent work with frequent team communication, especially when handling complex or appeal cases. This dynamic environment offers opportunities to continually expand your clinical knowledge while making important decisions that impact patient care and cost-effectiveness.

What are the key skills and qualifications for an Aetna Utilization Review?

Aetna Utilization Review professionals need a strong clinical background, such as RN licensure or equivalent healthcare qualifications, coupled with a deep understanding of medical necessity criteria and health plan guidelines. Familiarity with utilization management software, electronic health records (EHRs), and systems like InterQual or Milliman is typically required. Strong attention to detail, effective communication, and analytical thinking are soft skills that make candidates excel in this position. These abilities are crucial for ensuring appropriate care determinations, compliance with regulations, and clear communication between providers, patients, and payers.

What is an Aetna Utilization Review?

An Aetna Utilization Review job involves assessing medical treatments and services to ensure they are necessary, cost-effective, and align with Aetna's coverage policies. Professionals in this role review patient records, consult with healthcare providers, and apply clinical guidelines to determine appropriate care. They help manage healthcare costs while ensuring patients receive quality treatment. This role typically requires a background in nursing or healthcare and strong analytical skills.

How do you get into Aetna Utilization Review?

To become an Aetna Utilization Review professional, candidates typically need a relevant healthcare background such as nursing, medical assisting, or health administration, along with knowledge of insurance policies and medical coding. A valid state license or certification, such as a Registered Nurse (RN) or Certified Coding Specialist (CCS), is often required. Applying through Aetna's careers website and demonstrating strong analytical and communication skills are essential steps in the hiring process.
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Aetna Utilization Review jobs near you
Infographic showing various Aetna Utilization Review job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 90% In-person, and 10% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Staff Pharmacist

Saint Francis Hospital

Memphis, TN • On-site

$53 - $62.50/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 19 days ago

Job description

Provide pharmaceutical care services to the patients including, but not limited to oversight, monitoring, preparation, dispensing and proper documentation of patient medication therapy as well as providing drug information, patient information and oversight of information and dispensing systems. Additionally: ensures compliance with Federal, State, and local laws and regulations. May also advise physicians on medication utilization.
  • Review and monitor patient's medication therapy and orders written for safety and efficacy considering specific patient conditions and health status; advise patient care team on patient's medication therapy and document such interventions.
  • Order verification and performing medication profile reviews that should include but not limited to checking for duplications, drug- drug and drug-food interactions, allergies, drug appropriateness, dosing, and frequency.
  • Check High Risk IVs, renal dose adjusting medications, IV to PO conversions, initiates/modifies/discontinues therapy, and mediates black box warning interventions.
  • Ensure that appropriate medications are available for patients and properly procured, prepared, stored, and maintained.
  • Provide for collaborative practice management as per facility-approved protocols for anticoagulation, parenteral nutrition, vancomycin, and aminoglycoside consults, etc.
  • Performs related duties as required
  • equired:
    • Education: Pharm. D. or BS in Pharmacy
    • Licensure/Certification: Pharmacy license. AHA BLS, ACLS, PALS required if direct patient care responsibilities.
  • Preferred:
    • Experience: Hospital experience
    • Licensure/Certification: Board Certification in Pharmacotherapy (BCPS), CGP, etc.

Embark on a rewarding career with Saint Francis Hospital hospital. If you are a compassionate healthcare professional eager to contribute to patient care, this is your opportunity where your skills make a difference every day. Join us in delivering exceptional healthcare with a personal touch.
At Saint Francis Hospital, we understand that our greatest asset is our dedicated team of professionals. That's why we offer more than a job - we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:
  • Medical, dental, vision, and life insurance
  • 401(k) retirement savings plan with employer match
  • Generous paid time off
  • Career development and continuing education opportunities
  • Health savings accounts, healthcare & dependent flexible spending accounts
  • Employee Assistance program, Employee discount program
  • Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status
Saint Francis Hospital-Memphis is a 479-bed full-service hospital located at 5959 Park Avenue in Memphis, TN.Offering a wide array of medical services, Saint Francis is noted for its many Centers of Excellence, including its Center for Surgical Weight Loss, Joint & Spine Center, Heart & Vascular Center, Chest Pain Emergency Center, and Surgical Services including its Center for Robotic Surgery, Diabetes Center, and Cancer Center.The hospital has been recognized for excellence of care by United Healthcare, CIGNA, Blue Cross/Blue Shield, and Aetna. Saint Francis Hospital serves as an academic training site for University of Tennessee Surgical, Family Practice, and Psychiatric Residents. The hospital is accredited by the Joint Commission on the Accreditation of Healthcare Organizations, the nations oldest and largest hospital accreditation agency. At Saint Francis Healthcare, you can grow your career skills and be a vital member of our team where we strive to be No. 1 in quality, safety and service excellence. Join our team!

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