Utilization Review Nurse (UR Nurse) - 25-34403 Job at NavitsPartners, Glendale, AZ

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  • NavitsPartners
  • Glendale, AZ

Job Description

Job Title: Utilization Review Nurse (UR Nurse)

Schedule: Monday – Friday | 8:00 AM – 5:00 PM

Work Model: 100% Remote (Onsite visit required for equipment pickup)

Employment Type: Contract

Position Overview

The Utilization Review Nurse is responsible for monitoring and providing clinical oversight to ensure compliance with contractual, regulatory, and statutory requirements related to members’ physical/acute care and behavioral health services. This role supports appropriate utilization of healthcare services and serves as a clinical resource to internal and external stakeholders.

Key Responsibilities
  • Monitor overutilization and underutilization of healthcare services

  • Conduct utilization reviews, case file reviews, and audits

  • Provide technical assistance and clinical oversight to ensure compliance with applicable regulations and guidelines

  • Gather, analyze, organize, and evaluate information from multiple sources, including utilization data and medical records

  • Coordinate care with internal teams and external providers as needed

  • Make referrals for medically necessary covered services

  • Participate in clinical staffing and interdisciplinary reviews as required

  • Serve as a clinical resource for utilization management and covered service determinations

Required Experience & Qualifications
  • Bachelor of Science in Nursing (BSN)

  • Minimum 2 years of experience working as a Registered Nurse

  • Minimum 1 year of experience in behavioral health

  • Active Registered Nurse (RN) license in the applicable state

  • FPCC certification

Additional Information
  • No weekends required

  • Fully remote role with limited onsite requirement for equipment setup

Job Tags

Contract work, Monday to Friday,

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