Chicago, IL · On-site
Staff may be required to contact the providers of record, vendors, or internal Aetna departments to ... MUST HAVE UM experience, inpatient utilization management review. * MUST HAVE 1 YEAR OF UTILIZATION ...
Chicago, IL · On-site
Staff may be required to contact the providers of record, vendors, or internal Aetna departments to ... MUST HAVE UM experience, inpatient utilization management review. * MUST HAVE 1 YEAR OF UTILIZATION ...
The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced ... Knowledge of major insurance provider platforms (e.g., Optum, Aetna, BCBS, Cigna). * Strong ...
The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced ... Knowledge of major insurance provider platforms (e.g., Optum, Aetna, BCBS, Cigna). * Strong ...
What you will be doing? The Utilization Review (UR) Specialist is a critical member of the ... Knowledge of major insurance provider platforms (e.g., Optum, Aetna, BCBS, Cigna). * Strong ...
Quick apply
What you will be doing? The Utilization Review (UR) Specialist is a critical member of the ... Knowledge of major insurance provider platforms (e.g., Optum, Aetna, BCBS, Cigna). * Strong ...
Providence, RI · On-site
... Aetna departments to obtain additional information. · Evaluates documentation/information to ... utilization management review. · MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge ...
Providence, RI · On-site
... Aetna departments to obtain additional information. · Evaluates documentation/information to ... utilization management review. · MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge ...
This role works in close collaboration with medical staff leadership and the Medical Executive Board (MEB) designee to support peer review, utilization management, patient safety, and quality ...
This role works in close collaboration with medical staff leadership and the Medical Executive Board (MEB) designee to support peer review, utilization management, patient safety, and quality ...
This role works in close collaboration with medical staff leadership and the Medical Executive Board (MEB) designee to support peer review, utilization management, patient safety, and quality ...
This role works in close collaboration with medical staff leadership and the Medical Executive Board (MEB) designee to support peer review, utilization management, patient safety, and quality ...
This role works in close collaboration with medical staff leadership and the Medical Executive Board (MEB) designee to support peer review, utilization management, patient safety, and quality ...
This role works in close collaboration with medical staff leadership and the Medical Executive Board (MEB) designee to support peer review, utilization management, patient safety, and quality ...
This role works in close collaboration with medical staff leadership and the Medical Executive Board (MEB) designee to support peer review, utilization management, patient safety, and quality ...
This role works in close collaboration with medical staff leadership and the Medical Executive Board (MEB) designee to support peer review, utilization management, patient safety, and quality ...
Eligible to enroll in Medical plan on date of hire! LVN or RN Utilization Review Nurse ... Each executive report includes a summary, appropriate criteria/guidelines, and a rationale. This ...
Eligible to enroll in Medical plan on date of hire! LVN or RN Utilization Review Nurse ... Each executive report includes a summary, appropriate criteria/guidelines, and a rationale. This ...
Hudson, NY · On-site
$30.90 - $55.62/hr
Two years of acute care, utilization management, or payer experience required Ability to function ... Executive Director, Behavioral Health Services Responsible for: No direct staff supervision ...
Hudson, NY · On-site
$30.90 - $55.62/hr
Two years of acute care, utilization management, or payer experience required Ability to function ... Executive Director, Behavioral Health Services Responsible for: No direct staff supervision ...
Utilization Review * Discipline: RN * Start Date: 09/07/2026 * Duration: 13 weeks * 40 hours per ... .
Utilization Review * Discipline: RN * Start Date: 09/07/2026 * Duration: 13 weeks * 40 hours per ... .
Hudson, NY · On-site
$30.90 - $55.62/hr
Two years of acute care, utilization management, or payer experience required Ability to function ... Executive Director, Behavioral Health Services Responsible for: No direct staff supervision ...
Hudson, NY · On-site
$30.90 - $55.62/hr
Two years of acute care, utilization management, or payer experience required Ability to function ... Executive Director, Behavioral Health Services Responsible for: No direct staff supervision ...
Position Summary The Vice President of Utilization Review (VP of UR) provides strategic and ... This executive leader is responsible for developing, standardizing, optimizing, and overseeing ...
Position Summary The Vice President of Utilization Review (VP of UR) provides strategic and ... This executive leader is responsible for developing, standardizing, optimizing, and overseeing ...
Franklin, TN · On-site
$120 - $180/hr
Overview The Vice President of Utilization Review (VP of UR) provides strategic and operational ... This executive leader is responsible for developing, standardizing, optimizing, and overseeing ...
Franklin, TN · On-site
$120 - $180/hr
Overview The Vice President of Utilization Review (VP of UR) provides strategic and operational ... This executive leader is responsible for developing, standardizing, optimizing, and overseeing ...
Franklin, TN · On-site +1
Position Summary The Vice President of Utilization Review (VP of UR) provides strategic and ... This executive leader is responsible for developing, standardizing, optimizing, and overseeing ...
Franklin, TN · On-site +1
Position Summary The Vice President of Utilization Review (VP of UR) provides strategic and ... This executive leader is responsible for developing, standardizing, optimizing, and overseeing ...
Develops and establishes metrics, trends, and executive-level reporting for senior leadership ... Ensures annual review and regulatory compliance of utilization management plans. Preferred ...
Develops and establishes metrics, trends, and executive-level reporting for senior leadership ... Ensures annual review and regulatory compliance of utilization management plans. Preferred ...
Develops and establishes metrics, trends, and executive-level reporting for senior leadership ... Ensures annual review and regulatory compliance of utilization management plans. Preferred ...
Develops and establishes metrics, trends, and executive-level reporting for senior leadership ... Ensures annual review and regulatory compliance of utilization management plans. Preferred ...
Anchorage, AK · On-site
$2.8K/wk
Prime Staffing is seeking a travel nurse RN Utilization Review for a travel nursing job in ... executives.
Anchorage, AK · On-site
$2.8K/wk
Prime Staffing is seeking a travel nurse RN Utilization Review for a travel nursing job in ... executives.
The Group Director, Utilization Review will perform the functions necessary to support and advance ... Excel; executive communication and presentation skills including ability to use PowerPoint.
The Group Director, Utilization Review will perform the functions necessary to support and advance ... Excel; executive communication and presentation skills including ability to use PowerPoint.
Fairfield, CA · On-site
$2.7K/wk
Utilization Review * Discipline: RN * Start Date: 09/05/2026 * Duration: 13 weeks * 40 hours per ... Aetna • Supplemental dental, vision, and life insurance • Combination of taxable and non ...
Fairfield, CA · On-site
$2.7K/wk
Utilization Review * Discipline: RN * Start Date: 09/05/2026 * Duration: 13 weeks * 40 hours per ... Aetna • Supplemental dental, vision, and life insurance • Combination of taxable and non ...
$26.5K - $40.8K
11% of jobs
$40.8K - $55.1K
12% of jobs
$56.8K is the 25th percentile. Wages below this are outliers.
$55.1K - $69.5K
22% of jobs
The median wage is $77.4K / yr.
$69.5K - $83.8K
10% of jobs
$83.8K - $98.1K
9% of jobs
$98.1K - $112.4K
11% of jobs
$114.6K is the 75th percentile. Wages above this are outliers.
$112.4K - $126.7K
11% of jobs
$126.7K - $141K
4% of jobs
$141K - $155.4K
11% of jobs
$155.4K - $169.7K
0% of jobs
$169.7K - $184K
1% of jobs
$26.5K
$93.6K
$184K
| Aspect | Executive Aetna Utilization Review | Aetna Utilization Review Specialist |
|---|---|---|
| Credentials | Typically requires advanced certifications and experience in healthcare management | Requires relevant healthcare certifications, such as RN or licensed healthcare professional |
| Work Environment | Oversees review processes, manages teams, and interacts with higher management | Performs case reviews, assesses medical necessity, and documents findings |
| Employer & Industry Usage | Used in corporate healthcare settings, insurance companies, and administrative roles | Commonly employed within insurance companies and healthcare providers for claims review |
The main difference is that the Executive Aetna Utilization Review typically involves managerial responsibilities and strategic oversight, while the Aetna Utilization Review Specialist focuses on performing detailed case assessments and medical reviews. Both roles require healthcare knowledge, but the executive position emphasizes leadership and policy development.
Cities with the most Executive Aetna Utilization Review job openings:
The most popular types of Aetna Utilization Review jobs are:
States with the most job openings for Executive Aetna Utilization Review jobs include:
The top searched job categories for Executive Aetna Utilization Review jobs are:
Chicago, IL
Contract
Job Description:
Participates in the development and ongoing implementation of QM Work Plan activities.
Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives
Responsibilities:
Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.
Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.
Data gathering requires navigation through multiple system applications.
Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.
Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.
Responsible for the review and evaluation of clinical information and documentation.
Reviews documentation and interprets data obtained form clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.
Works Potential Quality of Care cases across all lines of business (Commercial and Medicare).
Independently coordinates the clinical resolution with internal/external clinician support as required.
Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data
Prepares and completes QM documents based on interpretation and application of business requirements
Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements
Assists in the development and implementation of QM projects and activities
Accountable for completing and implementation of QM Work Plan Activities
Experience:
3+ years of experience as an RN
Registered Nurse in state of residence
Must have prior authorization utilization experience
Experience with Medcompass
Skills:
MUST HAVE MEDCOMPASS or ASSURECARE exp.
MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge.
MUST HAVE UM experience, inpatient utilization management review.
MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG.
MUST HAVE 6 months of Prior Authorization.
Education:
Questionnaire:
Do you have experience with Medcompass?
Do you have experience with Prior Authorization?
Do you have experience with Utilization Review?
Do you have an Active Registered Nurse License?
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.
It services
1,001 - 5,000 Employees
Jersey City, NJ, US
2000
