ZipRecruiter

Log In

2

Remote Aetna Utilization Review Jobs (NOW HIRING)

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 ...

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 ...

Charlie Health

Utilization Review Specialist

Nashville, TN · Remote

$62K - $70K/yr

Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations ... REMOTE Please note that this role is not available to candidates in Alaska, Maine, Washington DC ...

KYYBA

Be Seen First

Remote Utilization Review RN

Detroit, MI · Remote

$35 - $39/hr

Utilization Review RN Contract Duration: 12+ months Job Location: 100% REMOTE License Requirements: MI Registered Nurse License Mandatory Requirements to Apply * Active, unrestricted Michigan ...

previous pagenext page

Showing results 21-40

All Jobsremote JobsHealthcare JobsNursing JobsNurse Case Manager JobsRemote Aetna Utilization Review Jobs

Remote Aetna Utilization Review information

See salary details

$21

$42

$68

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

As of Aug 23, 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 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.
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 August 2026, with employment types broken down into 77% Full Time, 6% Part Time, and 17% Contract. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Technician III

Prime Healthcare

Ontario, CA • On-site, Remote

$24.65 - $30.03/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 7 days ago

Prime Healthcare rating

6.4

Company rating: 6.4 out of 10

Based on 286 frontline employees who took The Breakroom Quiz

646th of 893 rated healthcare providers

Job description

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!
 


The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. This position will also serve as a liaison and own the coordination with other UR techs in the team while being responsible for coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. UR tech III will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The Utilization review tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.


  1. Bachelor’s degree or four years of relevant experience required.
  2. Microsoft office proficiency.
  3. Good communication skills

Preferred qualifications:

  1. Completion of a medical terminology course; preferred.
  2. Knowledge of HIPAA regulations preferred.

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $24.65 to $30.03. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.


Full Time
Days

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

 

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

What Prime Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply