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Manager Aetna Utilization Review Jobs (NOW HIRING)

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

Experience in utilization review or case management is highly beneficial, particularly within workers' compensation. Clinical experience involving orthopedic or neurological conditions is also highly ...

New

Acrisure

Utilization Review Nurse

Bradenton, FL

Experience in utilization review or case management is highly beneficial, particularly within workers' compensation. Clinical experience involving orthopedic or neurological conditions is also highly ...

New

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in ... Collaborate with physicians, case management, and care teams * Support discharge planning and care ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Experience in utilization review or case management is highly beneficial, particularly within workers' compensation. Clinical experience involving orthopedic or neurological conditions is also highly ...

New

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Manager Aetna Utilization Review information

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$91K

$167.5K

How much do manager aetna utilization review jobs pay per year?

As of Aug 17, 2026, the average yearly pay for manager aetna utilization review in the United States is $91,011.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,500.00 and $109,500.00 per year, depending on experience, location, and employer.

What does a manager in Aetna Utilization Review do?

A Manager of Aetna Utilization Review oversees the process of evaluating medical necessity, appropriateness, and efficiency of healthcare services for Aetna-insured members. They manage a team of utilization review nurses or specialists who review patient records and coordinate with healthcare providers to ensure compliance with Aetna’s policies. Their main goal is to ensure patients receive necessary care while controlling costs and preventing unnecessary treatments. Additionally, they may handle appeals, train staff, and implement process improvements.

What key skills and qualifications are needed to thrive as a manager in Aetna Utilization Review?

To thrive as a Manager in Aetna Utilization Review, you need a strong background in healthcare management, clinical knowledge (often as an RN or similar licensure), and experience with utilization review processes. Familiarity with case management software, medical coding systems, and compliance with regulatory requirements such as NCQA or URAC is typically expected. Leadership, decision-making, and communication skills are crucial for effectively guiding teams and collaborating with providers. These competencies ensure efficient care coordination, regulatory compliance, and high-quality patient outcomes in a complex healthcare environment.

How does a manager in Aetna Utilization Review typically collaborate with clinical teams and other departments to ensure effective patient care?

A Manager of Aetna Utilization Review works closely with clinical teams, case managers, and other departments to coordinate care and ensure that medical services are necessary and meet established guidelines. This role often involves reviewing patient cases, providing guidance on coverage decisions, and facilitating clear communication between healthcare providers and insurance representatives. Regular meetings and case discussions help to resolve complex cases and optimize patient outcomes. Effective collaboration is key to balancing cost efficiency with quality care, and managers are expected to foster a supportive environment that encourages teamwork and continuous improvement.

What is the difference between Manager Aetna Utilization Review vs Utilization Review Nurse?

AspectManager Aetna Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications like CCM or ANCC, and management experienceRegistered Nurse (RN) license, relevant certifications
Work EnvironmentSupervises utilization review teams, collaborates with healthcare providers, and manages case reviewsConducts patient case assessments, reviews medical records, and makes utilization decisions
Employer & Industry UsageCommonly employed by insurance companies like Aetna, healthcare organizations, and managed care firmsUsed within insurance companies, healthcare facilities, and third-party review organizations

The main difference is that the Manager Aetna Utilization Review oversees the review process and manages teams, while the Utilization Review Nurse focuses on conducting case assessments and medical reviews. Both roles require nursing credentials, but the manager position involves leadership and administrative responsibilities.

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Manager Aetna Utilization Review jobs near you
Infographic showing various Manager Aetna Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 12% Part Time, and 1% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $91,011 per year, or $43.8 per hour.

Utilization Review Nurse

Acrisure LLC

Bradenton, FL • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 2 days ago

New

Job description

About Acrisure
A global fintech leader, Acrisure empowers millions of ambitious businesses and individuals with the right solutions to grow boldly forward. Bringing cutting-edge technology and top-tier human support together, we connect clients with customized solutions across a range of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more.
In the last twelve years, Acrisure has grown in revenue from $38 million to almost $5 billion and employs over 19,000 colleagues in more than 20 countries. Acrisure was built on entrepreneurial spirit. Prioritizing leadership, accountability, and collaboration, we equip our teams to work at the highest levels possible.
Job summary:
Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines and regulatory requirements. This role reviews medical information submitted by treating providers, determines whether treatment can be authorized at the nurse level, and refers requests for physician review when additional clinical evaluation is required.
This position is ideal for an experienced LPN with a strong clinical background who enjoys applying their medical knowledge in an analytical, process-driven environment. Experience in utilization review or case management is highly beneficial, particularly within workers' compensation. Clinical experience involving orthopedic or neurological conditions is also highly valued.
This is a hybrid position with two days per week in the office and three days remote. Candidates must also have flexibility to periodically work a later schedule to support business needs across multiple time zones.
Responsibilities:
  • Review medical treatment requests and supporting clinical documentation for adherence to applicable state guidelines and utilization review requirements
  • Apply clinical knowledge and established guidelines to determine whether treatment requests can be authorized at the nurse level
  • Refer treatment requests requiring additional clinical evaluation to physicians for review
  • Evaluate medical records and treatment information to support timely and appropriate utilization review decisions
  • Complete required documentation and administrative processing throughout the utilization review process
  • Manage assigned reviews within applicable state-mandated and URAC turnaround requirements
  • Accurately document treatment requests, clinical information, review activity, and determinations within client records
  • Maintain confidentiality of medical and client information in accordance with HIPAA and applicable standards
  • Collaborate with physicians, healthcare providers, claims professionals, and internal team members to facilitate the review process
  • Maintain current clinical and industry knowledge relevant to utilization review and workers' compensation
  • Provide responsive service while managing multiple reviews and competing deadlines
Requirements:
  • Active LPN license required
  • Active multistate/compact nursing license required
  • Strong clinical nursing experience with the ability to review medical records and evaluate treatment requests
  • Ability to interpret medical terminology, treatment plans, and clinical documentation
  • Ability to apply established clinical guidelines and determine when requests require physician review
  • Flexibility to periodically work later hours to support business needs across multiple time zones
  • Workers' compensation utilization review experience highly beneficial
  • Utilization review or case management experience highly beneficial
  • Clinical experience involving orthopedic or neurological conditions strongly preferred
  • Strong organizational skills with the ability to prioritize a high volume of time-sensitive reviews
  • Strong written and verbal communication skills
  • Proficiency with Microsoft Office applications and ability to learn new clinical and claims systems
Education and licenses:
  • Active Licensed Practical Nurse (LPN) license required
  • Active multistate/compact nursing license required
  • Additional utilization review, case management, workers' compensation, or related professional certifications beneficial
Candidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.
Why Join Us:
At Acrisure, we're building more than a business, we're building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life, from your health and finances to your family and future.
Making a lasting impact on the communities it serves, Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan, UPMC Children's Hospital in Pittsburgh, Pennsylvania and Blythedale Children's Hospital in Valhalla, New York.
Employee Benefits
We also offer our employees a comprehensive suite of benefits and perks, including:
  • Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.
  • Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.
  • Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.
  • Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.
  • ... and so much more!

This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.
Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting leaves@acrisure.com.
Final candidates will be required to complete post-offer verification processes related to the role and in accordance with applicable laws.
California Residents: Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy.
Recruitment Fraud: Please visit here to learn more about our Recruitment Fraud Notice.
Welcome, your new opportunity awaits you.

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