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)