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Remote Aetna Utilization Review Jobs (NOW HIRING)

The Recovery Village

Utilization Review Specialist

$50K/yr

We are looking for a Remote Utilization Review Specialist Advanced Recovery Systems is an integrated behavioral healthcare management company dedicated to the treatment of addiction, substance abuse ...

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... Remote work from home * Full-time, Monday-Friday * Availability for occasional weekends and holiday ...

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;

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... This position is responsible for performing initial, concurrent review activities; discharge care ...

Medica

Utilization Review III

$70.20K - $120.40K/yr

The Utilization Review III position is responsible for the review, investigation, and resolution of ... This position is a Remote role. To be eligible for consideration, candidates must have a primary ...

Medica

Utilization Review III

Minnetonka, MN · Remote

$70.20K - $120.40K/yr

The Utilization Review III position is responsible for the review, investigation, and resolution of ... This position is a Remote role.To be eligible for consideration, candidates must have a primary ...

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ERC Pathlight

Utilization Review Manager

Denver, CO · On-site +1

$93K - $117K/yr

Remote : Mondays and Fridays * On-site in our Denver Office: Tuesdays, Wednesdays, and Thursdays The compensation range for this position is based upon candidate experience and market expectations.

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

As of May 29, 2026, the average hourly pay for remote 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 are the key skills and qualifications needed to thrive as a Remote Aetna Utilization Review nurse, and why are they important?

To thrive as a Remote Aetna Utilization Review nurse, you need an active RN license, strong clinical judgment, and experience in case management or utilization review. Familiarity with Aetna's systems, utilization management software, and knowledge of medical necessity criteria such as MCG or InterQual are typically required. Excellent communication, attention to detail, and time management are vital soft skills for coordinating care and efficiently handling remote assessments. These skills ensure accurate evaluations, regulatory compliance, and optimal resource utilization in a healthcare payer setting.

What are some common challenges faced in a remote Aetna Utilization Review role and how can they be managed?

One common challenge in a remote Aetna Utilization Review position is maintaining effective communication with healthcare providers and internal teams, as much of the coordination happens virtually. To manage this, professionals often rely on secure digital communication tools and establish clear protocols for timely responses. Another challenge is staying updated with changing healthcare regulations and Aetna policies, which requires proactive learning and frequent collaboration with colleagues. Developing strong organizational skills and participating in regular virtual team meetings can help ensure efficient workflow and compliance.

What are Remote Aetna Utilization Review jobs?

Remote Aetna Utilization Review jobs involve evaluating medical necessity, appropriateness, and efficiency of healthcare services provided to Aetna members. Professionals in these roles, often nurses or clinicians, review patient records and claims remotely to ensure treatments meet established guidelines and policies. The goal is to support quality care while managing healthcare costs and preventing unnecessary procedures. These positions require clinical experience, attention to detail, and familiarity with insurance processes.

What is the difference between Remote Aetna Utilization Review vs Remote UnitedHealthcare Utilization Review?

AspectRemote Aetna Utilization ReviewRemote UnitedHealthcare Utilization Review
CertificationsTypically requires nursing or healthcare-related licenses, certifications in utilization reviewSimilar licensing and certifications, often requiring nursing or healthcare credentials
Work EnvironmentRemote, healthcare insurance setting, reviewing medical necessity and coverageRemote, healthcare insurance setting, assessing medical claims and coverage appropriateness
Employer & Industry UsageUsed by Aetna insurance providers for member care managementUsed by UnitedHealthcare for claims review and member care decisions

Both Remote Aetna Utilization Review and Remote UnitedHealthcare Utilization Review involve remote assessments of medical necessity and coverage. They require similar healthcare credentials and operate within the health insurance industry, focusing on claims and member care management for their respective providers.

More about Remote Aetna Utilization Review jobs
What cities are hiring for Remote Aetna Utilization Review jobs? Cities with the most Remote 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 Remote Aetna Utilization Review jobs? States with the most job openings for Remote Aetna Utilization Review jobs include:
What job categories do people searching Remote Aetna Utilization Review jobs look for? The top searched job categories for Remote Aetna Utilization Review jobs are:
Remote Aetna Utilization Review jobs near you
Infographic showing various Remote Aetna Utilization Review job openings in the United States as of May 2026, with employment types broken down into 93% Full Time, 3% Part Time, and 4% Contract. Highlights an 82% Physical, 13% Hybrid, and 5% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Specialist

Utilization Review Specialist

The Recovery Village

Remote

$50K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 8 days ago

Job description

We are looking for a Remote Utilization Review Specialist
Advanced Recovery Systems is an integrated behavioral healthcare management company dedicated to the treatment of addiction, substance abuse, eating disorders and mental health issues. We put behavioral health front and center, providing assistance to people with substance abuse issues, addictions and mental health concerns. With facilities in various regions of the U.S., we have been furthering this mission since our inception, applying our advanced approach to patient care.
Every facility in the Advanced Recovery Systems network strives to provide the highest quality of care, using evidence-based therapeutic models that really work. Our goal is to help men, women and adolescents live healthy, happy lives without the burden of substance abuse or mental illness.
The Utilization Review Specialist (UR Specialist) is responsible for contacting external case managers/managed care organizations for pre-authorization and concurrent reviews throughout the duration of patient's treatment stay, and assists the treatment team in understanding the different requirements that various insurance companies have for admission, continued stay and discharge planning.
Core Job Duties:
  • Completes pre-authorizations/concurrent reviews/internal UR reviews
  • Consults with various members of the multidisciplinary treatment team concerning required information to complete concurrent reviews
  • Schedules peer to peer reviews and coordinates urgent/expedited appeals
  • Staffs individual cases with MDs as needed
  • Follows all standard ARS Utilization Review Department policies and procedures
  • Utilizes the UR Census Report on a daily basis
  • Makes all initial calls within 24 hours, and follow up calls every 24 hours
  • Data entry, records management and assisting with the appeals process
  • Completing detailed daily documentation
  • Works with Finance Department regarding client service authorizations
  • Communicating frequently with the treatment team
  • Other duties as assigned

Requirements
  • Bachelor's degree in a health or behavioral health related field required, Graduate degree in a health or behavioral health related field preferred, OR
  • High School diploma or equivalent and a State license (e.g., Registered Nurse, Licensed Practical Nurse, LCSW, LMHC) preferred
  • Minimum of three years' experience working in a psychiatric or chemical dependency setting
  • Minimum of three years' Utilization Review experience preferred
  • State licensure preferred (Registered Nurse, Licensed Practical Nurse, Licensed Clinical Social Worker, Licensed Mental Health Counselor)

Position Competencies:
  • Proficiency in establishing and maintaining positive and effective communication with managed care companies.
  • Ability to aligns medical and counseling staff to ensure services are provided at the appropriate level of care in a timely manner consistent with the patient's condition and in compliance with governmental and accrediting agencies.
  • Concurrent Reviews
  • Utilization Review
  • Census Report
  • ASAM criteria Ability to be resourceful and proactive in dealing with issues that may arise.
  • Demonstrate the ability to organize, multitask, prioritize and work under pressure.
  • Effective time management

Advanced Recovery Systems, a national integrated behavior healthcare management company dedicated to the treatment of addiction, substance abuse, eating disorders and mental health issues. We invite you to learn more about us at our website!
The Company complies with state and federal nondiscrimination laws and policies that prohibit discrimination based on age, color, disability, national origin, race, religion, or sex. It is unlawful to retaliate against individuals or groups based on the basis of their participation in a complaint of discrimination or on the basis of their opposition to discriminatory practices/EEO
We are proud to be a drug-free workplace.
Benefits
What we offer:
  • Starting pay $50,000/yr, based on experience.
  • Paid Time Off: Up to 2 weeks of paid time off per year plus sick pay & holiday pay
  • Benefits begin on the 1st day of the month following date of hire.
  • Matching HSA - up to $1500/yr contribution from the company to your HSA
  • 401(k), medical, dental, vision, and free Telehealth access
  • Employee Referral Bonus - you can earn up to $4000

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