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Remote Aetna Utilization Review Nurse Jobs (NOW HIRING)

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

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;

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

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 ...

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

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 ...

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 ...

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 ...

Netsmart

Utilization Review Nurse (PRN)

Review, analyze, and identify utilization patterns and trends, problems, or inappropriate ... Comfortable with remote work arrangements and virtual collaboration tools * Physical demands ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

The Utilization Review Nurse gathers demographic and clinical information on prospective ... This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Identifies the necessity of ...

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

As of Aug 15, 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 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.

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 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.
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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

Netsmart

Remote

Other

Posted 4 days ago

Netsmart rating

8.3

Company rating: 8.3 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

45th of 224 rated it services

Job description

Utilization Review Nurse

Responsible for utilization review work for emergency admissions and continued stay reviews. Responsibilities include:

  • Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria
  • Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources
  • Participate in telephonic discussions with emergency department physicians relative to documentation and admission status
  • Enter clinical review information into system for transmission to insurance companies for authorization
  • Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources

Qualifications required:

  • Current and unrestricted RN license
  • At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
  • At least 2 years utilization management experience in acute admission and concurrent reviews
  • Intermediate level experience with InterQual and/or MCG criteria within the last two years
  • Proficiency in medical record review in an electronic medical record (EMR)
  • Experience in Microsoft Suite including Office and basic Excel
  • Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs
  • Passing score(s) on job-related pre-employment assessment(s)

Preferred:

  • At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing
  • At least 3 years utilization management experience within the hospital setting
  • Bachelor's of Science in Nursing (BSN)
  • Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, Board Certified (CMGT-BC)

Expectations:

  • Comfortable with remote work arrangements and virtual collaboration tools
  • Physical demands include extended periods of sitting, computer use, and telephone communication

Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart's sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart's third party screening provider.

If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled.

All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.

Netsmart's Job Applicant Privacy Notice may be found here.

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