Behavioral Health Utilization Review Nurse - URNR#01

NavitsPartners • Phoenix, AZ

18d • $32 - $34 • Remote

About The Position

"Navitas Healthcare, LLC" is seeking an experienced Behavioral Health Utilization Review (UR) Nurse to support monitoring, compliance, and quality oversight for Fee-for-Service (FFS) and Serious Mental Illness (SMI) member populations. This role focuses on ensuring contractual, regulatory, and statutory compliance for physical/acute care services and behavioral health needs. The UR Nurse will analyze utilization trends, conduct clinical reviews and audits, and collaborate with internal and external stakeholders to support medically necessary, covered services.

Requirements

• Bachelor of Science in Nursing (BSN)
• Minimum of 2 years of experience as a Registered Nurse
• At least 1 year of experience in Behavioral Health
• Active Registered Nurse (RN) license in the required state
• FPCC certification (or equivalent, as applicable)

Responsibilities

• Monitor overutilization and underutilization of services
• Conduct utilization reviews, case file reviews, and clinical audits
• Provide oversight, guidance, and technical assistance related to care delivery
• Gather, organize, analyze, and evaluate data from multiple sources, including utilization reports and medical records
• Coordinate care with interdisciplinary teams and external partners
• Make referrals as appropriate to support member care needs
• Participate in clinical staffing and case discussions as needed
• Serve as a clinical resource regarding medically necessary covered services

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level