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Utilization Nurse (UR Nurse) Job Available in Phoenix Arizona

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Job Details

Utilization Nurse (UR Nurse)

Schedule:
Monday – Friday, 8:00 AM – 5:00 PM
No weekends

Work Arrangement:
100% Remote (candidate must go onsite once to receive equipment)

Position Summary:
The Utilization Nurse (UR Nurse) is responsible for providing monitoring and technical assistance to ensure compliance with contractual, regulatory, and statutory obligations for FFS/SMI members’ physical, acute care, and behavioral health needs.

This role involves reviewing and analyzing utilization data, coordinating care, and providing clinical oversight to ensure appropriate service delivery. The UR Nurse will also collaborate with internal and external stakeholders, participate in clinical staffing, and serve as a resource for medically necessary covered services.

Key Responsibilities:

  • Monitor overutilization and underutilization of services.

  • Conduct case reviews, audits, and utilization monitoring.

  • Provide oversight, guidance, and technical assistance to ensure compliance.

  • Gather, organize, and evaluate information from multiple data sources.

  • Coordinate care with internal and external stakeholders.

  • Make referrals as appropriate and participate in clinical staff meetings.

  • Ensure members receive medically necessary covered services.

Experience Required:

  • Bachelor of Science in Nursing (BSN)

  • Minimum of 2 years of RN experience

  • At least 1 year of experience in behavioral health

Requirements:

  • Active RN license in the State of Arizona

  • Fingerprint Clearance Card (FPCC)

Qualifications

  • Must be at least 18 years of age
  • Strong customer service and communication skills required
  • Ability to work a flexible work schedule including nights, weekends and holidays
  • Ability to lift, carry, push, and pull a minimum of 50 pounds required
  • Ability to unload freight, to move product on and off of store shelves, to walk, stand, bend, stoop, or kneel for long periods of time, and to move freely throughout store on a continual basis required
  • Basic English literacy and math skills required
  • We will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws
  • full-time
  • No Degree mentioned

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