ZipRecruiter

Log In

2

Remote Aetna Utilization Review Jobs in Indiana (NOW HIRING)

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · On-site +1

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database users' needs to estimate time and cost required to ...

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · Remote

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database users' needs to estimate time and cost required to ...

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · Remote

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database users' needs to estimate time and cost required to ...

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · Remote

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database user needs to estimate time and cost required to ...

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · Remote

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database user needs to estimate time and cost required to ...

A.C. Coy

Cobol/IDMS Developer (Remote)

Indianapolis, IN · On-site +1

$48 - $65/hr

... and utilization of electronic data processing systems for product and commercial software ... Review project requests describing database user needs to estimate time and cost required to ...

Cayenta

... reviews and documentation, and requirements elicitation, allowing the project team to gain a ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

CEI Services

Vice President of Equipment

Clinton, IN · On-site +1

Location: Remote. Company Overview MasTec Renewables, comprised of Wanzek Construction, IEA ... Oversee equipment records management and implement regular reviews to assess performance ...

next page

Showing results 1-20

All JobsAetna Utilization Review JobsRemote Aetna Utilization Review JobsRemote Aetna Utilization Review Jobs in Indiana

Remote Aetna Utilization Review information

What is a remote Aetna Utilization Review?

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 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 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 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.

Does Aetna have remote jobs?

Aetna offers remote positions, including roles like Remote Utilization Review, which often require healthcare knowledge and familiarity with medical records. These jobs typically involve working from home with flexible schedules and may require relevant certifications or experience in healthcare or insurance industries.

Is remote Aetna utilization review work from home?

Remote Aetna utilization review jobs are often performed from home, allowing employees to review medical cases and authorization requests remotely. These roles typically require strong computer skills, familiarity with healthcare software, and adherence to confidentiality standards, with many positions offering flexible or full-time remote schedules.

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

The most popular types of Aetna Utilization Review jobs in Indiana are:

What are popular job titles related to Remote Aetna Utilization Review jobs in Indiana?

For Remote Aetna Utilization Review jobs in Indiana, the most frequently searched job titles are:

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

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

What cities in Indiana are hiring for Remote Aetna Utilization Review jobs?

Cities in Indiana with the most Remote Aetna Utilization Review job openings:

Remote Aetna Utilization Review jobs near you
Infographic showing various Remote Aetna Utilization Review job openings in Indiana as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Clinical Domain Project Manager (PBM)

Indianapolis, IN • On-site, Remote

Briljent
Business Schools and Computer and Management Training • 51 - 200 employees
Learn more about Briljentexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 22 days ago

Job description

The Clinical Domain Project Manager plans, coordinates, and delivers pharmacy clinical initiatives within a Medicaid, pharmacy benefit management (PBM), and healthcare payer environment. This role serves as the primary liaison between business stakeholders, clinical pharmacists, operational teams, technology teams, and external partners to ensure successful implementation of pharmacy clinical solutions and regulatory requirements. Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and pharmacy system implementations, with accountability for project governance, schedule management, stakeholder communications, risk management, and delivery of business outcomes. This is a fully remote, full time engagement with an anticipated duration of ten months and an immediate start. No travel is required, and a background check must be successfully completed prior to onboarding.
Must be eligible to work in the United States. No sponsorships are available at this time.
Essential Duties:
Project Leadership and Delivery:
  • Leads pharmacy clinical projects through initiation, planning, execution, monitoring, and closure
  • Develops and maintains integrated project plans, schedules, milestones, dependencies, and deliverables
  • Facilitates requirements gathering, design reviews, solution validation, testing, and implementation activities
  • Coordinates cross-functional teams across clinical, operational, technical, and business workstreams
  • Manages project budgets, scope, schedule, risks, issues, assumptions, and dependencies
  • Supports implementation and enhancement of drug coverage administration, Preferred Drug List (PDL) management, prior authorization (PA) programs, electronic prior authorization (ePA), and drug utilization review (DUR)
  • Ensures clinical program requirements are accurately translated into system and operational solutions

Stakeholder Engagement:
  • Serves as primary point of contact for client, clinical, and internal project stakeholders
  • Facilitates decision-making discussions and executive governance meetings
  • Communicates project status, risks, issues, and mitigation strategies to leadership
  • Builds collaborative relationships with pharmacy directors, clinical pharmacists, business analysts, product teams, and external vendors

Compliance and Regulatory Oversight:
  • Ensures project deliverables comply with federal and state Medicaid requirements
  • Supports readiness for audits, regulatory reviews, and contractual reporting obligations
  • Coordinates implementation efforts involving the Centers for Medicare and Medicaid Services (CMS), Medicaid agencies, pharmacy benefit managers (PBMs), and healthcare partners as applicable
  • Maintains traceability between business requirements, design decisions, testing results, and implemented solutions

Vendor and Partner Coordination:
  • Coordinates activities with PBMs, pharmacy system vendors, clinical review organizations, and state stakeholders
  • Manages integration and dependency tracking across external partners
  • Facilitates issue resolution and escalation management to meet project objectives

Implementation and Transition:
  • Leads implementation readiness reviews and go-live planning activities
  • Coordinates training, deployment, cutover, and stabilization efforts
  • Develops implementation plans, communication strategies, and transition-to-operations procedures
  • Supports continuous improvement initiatives and lessons-learned activities

Requirements
Required Skills:
  • Demonstrated success leading large-scale healthcare or pharmacy benefit management (PBM) implementations
  • Experience managing multiple workstreams and vendors simultaneously
  • Experience leading end-to-end lifecycle activities from project startup through post go-live support
  • Experience with Preferred Drug List (PDL) administration
  • Experience with prior authorization (PA) programs
  • Experience with electronic prior authorization (ePA) and drug utilization review (DUR)
  • Experience with clinical policy administration and utilization management initiatives
  • Expert-level schedule performance management using Microsoft Project
  • Deliverable management, including Medicaid deliverable oversight
  • Risks, actions, issues, and decisions (RAID) management
  • Project controls based on the Project Management Body of Knowledge (PMBOK)
  • Cross-domain coordination across claims, provider, member, clinical, rebate, and portal functions

Education and Experience:
  • Seven or more years of project management experience
  • Seven or more years of experience supporting Pharmacy Benefit Management (PBM) Medicaid programs
  • Project Management Professional (PMP) certification preferred, not required

Physical Requirements & Environmental Conditions: An employee must meet these physical demands to successfully perform the essential functions of this job. Employee is regularly required to talk or hear, sit, stand, and utilize technology tools such as a laptop computer for extended periods of time. Specific vision abilities include close vision and the ability to adjust focus. This position requires the ability to occasionally lift up to 20 lbs. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Briljent is a solutions-based company. Solutions come from creative ideas; ideas come from being creative with differences. Briljent believes diversity and inclusion are critical to the success of the company. Employment at Briljent is based on merit and professional qualifications. We do not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status or any other basis protected by federal, state or local law, regulation or ordinance.
Benefits
  • Health Care Plan (Medical, Dental & Vision)
  • Retirement Plan (401k, IRA)
  • Life Insurance (Basic, Voluntary & AD&D)
  • Paid Time Off (Vacation, Sick & Public Holidays)
  • Short Term & Long Term Disability
  • Work From Home
  • Wellness Resources

Apply