Utilization Nurse (UR Nurse)
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Job Location:
Phoenix, NM - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
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)
Key Skills
- EMR Systems
- Hospital Experience
- Acute Care
- ICU Experience
- Dermal Fillers
- Experience Administering Injections
- Home Care
- Nursing
- Botox Experience
- Critical Care Experience
- Medication Administration
- Tube Feeding
About Company
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