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Full Time Aetna Utilization Review Jobs (NOW HIRING)

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 ...

UHS

Utilization Review Coordinator

Brookline, MA · On-site

Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time Utilization Review Coordinator to join our skilled and dedicated team of psychiatric professionals ...

UHS

Utilization Review Coordinator

Brookline, MA · On-site

Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time Utilization Review Coordinator to join our skilled and dedicated team of psychiatric professionals ...

Umpqua Health

Utilization Review Specialist

Winston, OR · On-site

$41K - $47K/yr

Utilization Review Specialist HYBRID, must be able to travel to 3031 NE STEPHENS ST ... ROSEBURG, OR 97470 EMPLOYMENT TYPE- Full-Time, Exempt About Umpqua Health At Umpqua Health, we're ...

UHS

Utilization Review Coordinator

Champaign, IL · On-site

$61K - $71K/yr

Responsibilities Full-time Utilization Review Coordinator Opening The Pavilion Behavioral Health System has been the leading provider of behavioral health and addictions treatment for families in ...

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Full Time Aetna Utilization Review information

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How much do full time aetna utilization review jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for full time 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 is the difference between Full Time Aetna Utilization Review vs Full Time Aetna Claims Analyst?

AspectFull Time Aetna Utilization ReviewFull Time Aetna Claims Analyst
CertificationsTypically requires healthcare or insurance-related certificationsOften requires claims processing or insurance certifications
Work EnvironmentHealthcare settings, insurance companies, or remoteInsurance companies, healthcare payers, or remote
Job FocusReviewing medical necessity and appropriateness of careProcessing and analyzing insurance claims for accuracy
Common UsageUsed in utilization management and care coordinationUsed in claims processing and reimbursement

Full Time Aetna Utilization Review focuses on evaluating medical necessity and care appropriateness, while Full Time Aetna Claims Analyst handles claims processing and reimbursement. Both roles require insurance or healthcare certifications and are vital in the insurance industry, often working in similar environments but with distinct responsibilities.

What cities are hiring for Full Time Aetna Utilization Review jobs? Cities with the most Full Time Aetna Utilization Review job openings:
What are the most commonly searched types of Aetna Utilization Review jobs? The most popular types of Aetna Utilization Review jobs are:
What states have the most Full Time Aetna Utilization Review jobs? States with the most job openings for Full Time Aetna Utilization Review jobs include:
Full Time Aetna Utilization Review jobs near you

Utilization Review Nurse

Oscar Health

Tempe, AZ • Remote

$35 - $45.94/hr

Full-time

Re-posted 28 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

251st of 304 rated insurance

Job description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

  • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
  • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
  • Meet required decision-making SLAs
  • Refer members for further care engagement when needed
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
  • Ability to obtain additional state licenses to meet business needs
  • 1+ year of utilization review experience in a managed care setting
  • Strong experience utilizating MCG (Milliman Care Gudielines)
  • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
  • Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

  • BSN
  • Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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