ZipRecruiter

Log In

2

Remote Aetna Utilization Review Nurse Jobs (NOW HIRING)

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Netsmart

Utilization Review Nurse

Utilization Review Nurse Responsible for utilization review work for emergency admissions and ... Comfortable with remote work arrangements and virtual collaboration tools * Physical demands ...

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 ... 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 ...

McBee Associates

Utilization Review Nurse

Responsible for utilization review work for emergency admissions and continued stay reviews ... Comfortable with remote work arrangements and virtual collaboration tools * Physical demands ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ... Days, Primarily remote; onsite orientation requirement; weekend and holiday rotation; on site ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

Utilization Review Nurse Remote Ability to travel on-site to 3031 NE Stephens St., Roseburg OR, 97457, as needed for business operations. Employment Type: Full-Time, Exempt About Umpqua Health At ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97470, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97470, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

University of Utah

Utilization Review Nurse

Refers to UR committee any case that surpasses expected LOS, expected cost, or over/under-utilization of resources. * Performs verbal/fax clinical review with payer as determined by nursing judgment ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97470, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

CorVel

CA Utilization Review Nurse I

$30.64 - $45.80/hr

Utilization Review Nurse The Utilization Review Nurse gathers demographic and clinical information ... This is a remote position. Essential Functions & Responsibilities: * Identifies the necessity of ...

next page

Showing results 1-20

All JobsAetna Utilization Review Nurse JobsRemote Aetna Utilization Review Nurse Jobs

Remote Aetna Utilization Review Nurse information

See salary details

$21

$42

$68

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

As of Aug 17, 2026, the average hourly pay for remote aetna utilization review nurse 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 a Remote Aetna Utilization Review Nurse?

A Remote Aetna Utilization Review Nurse is a registered nurse who works from home or another remote location to review medical records and determine the necessity and appropriateness of healthcare services for Aetna insurance members. Their primary role is to ensure that patients receive the right care at the right time, according to established guidelines and insurance policies. They collaborate with healthcare providers, patients, and insurance teams to make coverage decisions, manage authorizations, and support quality care while controlling healthcare costs.

What are the key skills and qualifications needed to thrive as a Remote Aetna Utilization Review Nurse?

To thrive as a Remote Aetna Utilization Review Nurse, you need a current RN license, strong clinical assessment abilities, and experience in case management or utilization review. Familiarity with healthcare management software, Aetna's proprietary systems, and knowledge of insurance guidelines and regulatory standards are essential. Excellent communication, critical thinking, and time management skills help you effectively coordinate care and interact with patients, providers, and payers. These competencies ensure accurate, timely utilization reviews that support patient care quality and cost-effective healthcare delivery.

How does a Remote Aetna Utilization Review Nurse typically collaborate with physicians and other healthcare providers while working remotely?

As a Remote Aetna Utilization Review Nurse, collaboration with physicians and other healthcare providers is primarily conducted through secure digital platforms, emails, and phone calls. Nurses regularly communicate with providers to clarify medical information, discuss clinical documentation, and ensure that care decisions align with Aetna's medical policies and guidelines. While working remotely, maintaining strong communication skills and being responsive to queries are crucial for effective teamwork and efficient case resolution. This virtual collaboration helps ensure members receive appropriate, cost-effective care while adhering to regulatory and organizational standards.

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

AspectRemote Aetna Utilization Review NurseRemote Case Manager
CertificationsRN license, Utilization Review certification often preferredRN license, Case Management certification (CCM or ACM) often preferred
Work EnvironmentHealthcare insurance company, clinical review settingHealthcare insurance or managed care, patient coordination
Employer & IndustryInsurance providers like Aetna, healthcare industryInsurance companies, healthcare organizations, managed care

Both roles involve patient assessment and healthcare review, but the Remote Aetna Utilization Review Nurse focuses on clinical review for insurance authorization, while the Remote Case Manager emphasizes coordinating patient care and discharge planning. They share similar certifications and work environments but differ in daily responsibilities and focus areas.

More about Remote Aetna Utilization Review Nurse jobs

What cities are hiring for Remote Aetna Utilization Review Nurse jobs?

Cities with the most Remote Aetna Utilization Review Nurse job openings:

What are the most commonly searched types of Aetna Utilization Review Nurse jobs?

The most popular types of Aetna Utilization Review Nurse jobs are:

What states have the most Remote Aetna Utilization Review Nurse jobs?

States with the most job openings for Remote Aetna Utilization Review Nurse jobs include:

What job categories do people searching Remote Aetna Utilization Review Nurse jobs look for?

The top searched job categories for Remote Aetna Utilization Review Nurse jobs are:

Remote Aetna Utilization Review Nurse jobs near you
Infographic showing various Remote Aetna Utilization Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Oscar Health

Miami, FL • Remote

$35 - $45.94/hr

Full-time

Posted 25 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

257th of 309 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.

What Oscar Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom