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Position Aetna Utilization Review Jobs (NOW HIRING)

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... This position collaborates closely with clinical teams, insurance providers, and other healthcare ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... This position collaborates closely with clinical teams, insurance providers, and other healthcare ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... This position collaborates closely with clinical teams, insurance providers, and other healthcare ...

UHS

Utilization Review Coordinator

Mountain City, TN · On-site

Utilization Review Coordinator Position Summary Mountain Youth Academy is nestled in Mountain City, Tennessee which is a short commute from Johnson City, TN, Boone, NC, and Abingdon, VA. We are a 120 ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

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;

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Position Aetna Utilization Review information

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$42

$68

How much do position aetna utilization review jobs pay per hour?

As of Jul 15, 2026, the average hourly pay for position 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 Position Aetna Utilization Review vs Medical Reviewer?

AspectPosition Aetna Utilization ReviewMedical Reviewer
CredentialsRN, LPN, or licensed healthcare professionalMD, DO, or licensed healthcare provider
Work EnvironmentInsurance company, primarily office-basedHospitals, clinics, or insurance settings
Industry UsageCommonly employed in health insurance companies like AetnaUsed across healthcare facilities and insurance companies

Position Aetna Utilization Review involves assessing insurance claims and determining coverage based on medical necessity, often performed by licensed healthcare professionals. Medical Reviewers, typically physicians, evaluate medical records and provide expert opinions on patient care. While both roles require healthcare credentials, Aetna Utilization Review focuses on insurance processes, whereas Medical Reviewers focus on clinical assessments.

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What cities are hiring for Position Aetna Utilization Review jobs? Cities with the most Position Aetna Utilization Review job openings:
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Position Aetna Utilization Review jobs near you
Infographic showing various Position Aetna Utilization Review job openings in the United States as of July 2026, with employment types broken down into 47% Locum Tenens, 25% Internship, 18% Full Time, 2% Part Time, and 8% Summer. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Nurse

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL

Full-time

Posted 7 days ago

Job description

Job Summary: We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

· Clinical Assessment: Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
  • Revenue Cycle Management: Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.
  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  • Documentation Improvement: Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.


  • Data Analysis: Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.


  • Compliance: Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

· Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

· Bachelor of Science in Nursing (BSN) preferred.

· Case Management Certification (e.g., CCM) is a plus.

· Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

· Minimum 2 years of work experience in Utilization Review

· Strong understanding of revenue cycle management and healthcare reimbursement.

· Proficiency in medical coding and clinical documentation improvement.

· Excellent communication, interpersonal, and teamwork skills.

· Ability to work independently and make sound clinical and financial decisions.

· Strong analytical and problem-solving skills.

· Proficient in using healthcare information systems and technology.

· Commitment to maintaining patient confidentiality and ethical standards.

Apply