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Remote Aetna Utilization Review Jobs (NOW HIRING)

VIVA USA INC

Utilization Review Nurse

Nashville, TN · On-site +1

$37.22 - $42.22/hr

... all Utilization Management activities to include review of inpatient and outpatient medical ... Remote Contract to Hire VIVA is an equal opportunity employer. All qualified applicants have an ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105.34K/yr

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

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105.34K/yr

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

CommonSpirit Health

THIS IS A REMOTE JOB: Responsibilities: * Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based ...

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

As of May 29, 2026, the average hourly pay for remote aetna utilization review 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 are the key skills and qualifications needed to thrive as a Remote Aetna Utilization Review nurse, and why are they important?

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 are Remote Aetna Utilization Review jobs?

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 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.

More about Remote Aetna Utilization Review jobs
What cities are hiring for Remote Aetna Utilization Review jobs? Cities with the most Remote Aetna Utilization Review job openings:
What are the most commonly searched types of Aetna Utilization Review jobs? The most popular types of Aetna Utilization Review jobs are:
What states have the most Remote Aetna Utilization Review jobs? States with the most job openings for Remote Aetna Utilization Review jobs include:
What job categories do people searching Remote Aetna Utilization Review jobs look for? The top searched job categories for Remote Aetna Utilization Review jobs are:
Remote Aetna Utilization Review jobs near you
Infographic showing various Remote Aetna Utilization Review job openings in the United States as of May 2026, with employment types broken down into 93% Full Time, 3% Part Time, and 4% Contract. Highlights an 82% Physical, 13% Hybrid, and 5% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Nurse

Utilization Review Nurse

VIVA USA INC

Nashville, TN • On-site, Remote

$37.22 - $42.22/hr

Contractor

Posted 25 days ago

Job description

Job Description
Registered Nurse responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: drugs and biologics, inpatient admissions, outpatient services, surgical and diagnostic procedures, home health, durable medical equipment and out of network services. Conduct reviews in compliance with medical policy, member eligibility, benefits, and contracts.
Essential Duties and Responsibilities:
Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies and compliance guidelines.
Uses an established set of criteria to evaluates and authorize the medical necessity of services.
Provide notification of decisions in accordance with compliance guidelines.
Coordinate with Medical Directors when services do not meet criteria or require additional review.
Participation in staff meetings, regular trainings and other collaborative meetings as appropriate.
Works with management team to achieve operational objectives and financial goals.
Supports teams across UM Department as needed.
Active participation and completion of all required trainings.
Maintain Required Licensures.
Adherence to regulatory and departmental timeframes for review of requests
Meet/exceed department Turn Around time, daily established productivity goals, and service levels
Proficient knowledge of policies and procedures, Medicare, HIPPA and NCQA standards;
Professional demeanor and the ability to work effectively within a team or independently;
Flexible with the ability to shift priorities when required
Other duties as required
Qualifications:
Current unrestricted RN license. Multi-State License Preferred
Bachelor's degree in nursing or health-care related field preferred
Minimum of 2 years' experience in a regulated environment preferred
Minimum of 2-3 years clinical experience
Strong customer orientation
Strong organizational, planning, and communication skills
Working knowledge of insurance industry, medical coding (CPT/HCPCS/ICD-10), and overall claims process a plus
Knowledge of National Coverage Determinations, Local Coverage Determinations and MCG criteria are a plus.
Excellent time management skills
Knowledge, Skills, Abilities Required:
Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member
Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments
Able to work in a dynamic, fast-paced team environment and to promote team concepts
Excellent typing skills.
Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word.
Required Qualifications:
RN
Notes:
Remote
Contract to Hire
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

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