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Remote Aetna Utilization Review Jobs in Rochester, NY

Athena

LCSW Clinical Supervisor - Remote

Rochester, NY · Remote

$60 - $65/hr

While this is a remote position, candidates must reside in or be willing to relocate to one of the ... Engage in the Utilization Review process for assigned cases every month * Respond to clinical ...

Delaware North

Workforce Planner

Farmington, NY · On-site +1

$62K/yr

Partner with operations to maximize the utilization of UKG Dimensions and VR, adhering to best ... Review and update weekly volume forecasts for key KPIs, aligning with productivity standards, and ...

Delaware North

Workforce Planner

Farmington, NY · On-site +1

$62K/yr

Partner with operations to maximize the utilization of UKG Dimensions and VR, adhering to best ... Review and update weekly volume forecasts for key KPIs, aligning with productivity standards, and ...

Delaware North

Workforce Planner

Farmington, NY · On-site +1

$62K/yr

Partner with operations to maximize the utilization of UKG Dimensions and VR, adhering to best ... Review and update weekly volume forecasts for key KPIs, aligning with productivity standards, and ...

All JobsAetna Utilization Review JobsRemote Aetna Utilization Review JobsRemote Aetna Utilization Review Jobs in Rochester, NY

Remote Aetna Utilization Review information

See Rochester, NY salary details

$21

$41

$68

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

As of Aug 26, 2026, the average hourly pay for remote aetna utilization review in Rochester, NY is $41.72, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 per hour, depending on experience, location, and employer.

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 Rochester, NY?

The most popular types of Aetna Utilization Review jobs in Rochester, NY are:

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

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The top searched job categories for Remote Aetna Utilization Review jobs in Rochester, NY are:

What cities near Rochester, NY are hiring for Remote Aetna Utilization Review jobs?

Cities near Rochester, NY with the most Remote Aetna Utilization Review job openings:

Remote Aetna Utilization Review jobs near you

LCSW Clinical Supervisor - Remote

Rochester, NY • Remote

Athena
See more jobs at Athenaexternal

$60 - $65/hr

Part-time

Re-posted 13 days ago

Job description

While this is a remote position, candidates must reside in or be willing to relocate to one of the following states prior to their start date:

Colorado, Connecticut, District of Columbia (Washington, D.C.), Florida, Massachusetts, Maryland, North Carolina, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Washington

*Must be licensed in NY or open to obtaining NY credentials!

Athena Mental Health is a New York State mental health-approved provider of community mental health services for children, adults, and families with behavioral and emotional challenges.  We specialize in individual and group psychotherapy for clients with a focus on trauma-informed care. We are dedicated to improving the quality and accessibility of mental health care for all, especially individuals from underserved communities.
 
Here at Athena, we pride ourselves on hiring a diverse group of mental health clinicians and staff who are passionate and dedicated to improving our clients’ overall emotional well-being. We provide both in-person and telehealth services for our clients and offer a competitive fee-for-service compensation plan and amazing benefits to our staff. 
 
Are You a Good Fit For Us?
We are currently seeking professional and compassionate Clinical Supervisors to join our growing team. Flexible hours are provided with the need of one weekend day and some evenings. In-person and telehealth sessions are conducted by our clinicians.
Responsibilities
  • Provide weekly clinical supervision to therapists as assigned, and document supervision sessions in a timely manner
  • Complete and maintain NYS licensure paperwork for supervisees as applicable
  • Assist with the development and facilitation of clinical training for staff in partnership with the leadership team
  • Work with the Clinical Director to cover administrative tasks as needed, including performance management of assigned therapists when necessary
  • Perform ongoing review of high-risk cases and provide clinical solutions as appropriate
  • Engage in the Utilization Review process for assigned cases every month
  • Respond to clinical crises and other clinical issues brought forward by supervisees
  • Help develop and improve clinical policies and procedures on an ongoing basis to support overall success of the program
  • Maintain a reduced caseload of therapy clients; complete all required clinical documentation promptly, including comprehensive assessments, treatment plans, and progress notes
Qualifications
  • NYS Independently Licensed Mental Health Provider (PhD, LCSW, LCSW-R, etc.)
  • Leadership experience in a mental health clinic setting
  • Bilingual in English and Spanish is preferred, but not required 
  • Previous experience using computerized appointment scheduling systems and/or electronic Medical Record Systems
  • Knowledgeable in NYS OMH Outpatient Clinic regulations
  • Knowledgeable in HIPAA Regulations
This is a fee-for-service role where you are compensated at a base rate per supervisory session.
Working Conditions
This position will be located at either the Manhattan office at 33 West 60th Street, New York, NY 10023, Suite 600, the Bronx office at 2825 Third Avenue, Suite 402, Bronx, NY 10455, 1299 Portland Ave, Suite 1, Rochester, NY 14621, or remotely. This is a professional work environment where a computer, desk, chair, and office supplies will be essential.
 
Physical Requirements
The physical demands described here are representative of those that must be met by an employee in order to successfully perform the essential functions of the role above. While performing the duties of this job, the employee is regularly required to hear and speak on the phone or through virtual telehealth sessions conducted on a computer throughout the day, stand and sit for an extended period of time and be able to write and answer emails in addition to carrying objects no greater than 25 pounds, when needed.
 
Direct Reports
This position has direct reports.
 
Athena is an Equal Opportunity Employer.
 
Note: We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for qualified applicants/employees to perform essential job functions. 

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.