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Remote Aetna Utilization Review Nurse Jobs (NOW HIRING)

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... For positions that are available as remote work, Sentara Health employs associates in the following ...

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 ...

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 ...

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 ...

Personify Health

Utilization Review Nurse - RN

$35 - $43/hr

Current, unrestricted RN license in the United States or a U.S. territory (compact license accepted ... Utilization review/utilization management experience preferred Technical Skills: * Proficiency with ...

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

As of Sep 7, 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:

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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, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

UTILIZATION REVIEW NURSE

Sentara Healthcare

Norfolk, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 13 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 417 frontline employees who took The Breakroom Quiz

498th of 898 rated healthcare providers

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.
The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Education:
• BSN (preferred)
Certification:
• Registered Nurse (required)
Experience:
• 3 years of acute care clinical experience (required)
• Previous Utilization Review experience (preferred)
• Milliman experience (preferred)
• Knowledge of NCQA (preferred)
• Microsoft suite (Word, Excel, Outlook) (preferred)
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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