Part-Time Utilization Review Nurse; Remote – Nevada RN

Overview

Join to apply for the Part-Time Utilization Review Nurse (Remote – Nevada RN) role at CCMSI
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At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem‑solving, and an unwavering commitment to client success.

We’re seeking a Part‑Time Utilization Review Nurse to conduct medical necessity reviews for treatment requests related to workers’ compensation claims. This fully remote (Nevada‑based) role is ideal for a nurse who thrives in a structured, detail‑driven environment and enjoys applying clinical judgment to ensure quality, appropriate care.

Location:

Remote (Reporting to Carson City, NV)

Schedule:

Monday–Friday, 8:00 AM–12:00 PM PST
Compensation: $40,000–$45,000 annually (part‑time, 20 hours/week)
Travel:
Once per year to Carson City, NV

Reports To:

Utilization Review Nurse Supervisor

• Review provider‑submitted treatment requests, apply evidence‑based guidelines, and issue determinations in accordance with Nevada’s utilization review standards.
• Apply the NAC 616C.123 criteria, ACOEM Practice guidelines, and other medical criteria, including Official Disability Guidelines and Medical Disability Guidelines, to evaluate medical necessity and reasonableness.
• Report diagnoses, ICD‑9 codes, medical appropriateness, physical findings, diagnostic and therapeutic procedures, concurrent problems, follow‑up care, and functional limitations of injured employees.
• Authorize determinations based on clinical requirements, medical necessity, and reasonableness per appropriate medical guidelines.
• Process requests in accordance with timelines specified in Nevada Revised Statute and Nevada Administrative Code.

• Active, unrestricted Nevada nursing license (RN).
• Nursing degree (Associate’s or Bachelor’s).
• Prior utilization review experience.
• Strong clinical background; ability to evaluate complex medical information.
• Excellent written and verbal communication skills.
• High attention to detail with the ability to shift priorities as needed.
• Proficiency with Microsoft Office and electronic documentation systems.

• Experience in trauma, orthopedics, occupational medicine, rehab therapy, med‑surg, or workers’ compensation.
• Exceptional organizational skills and the ability to work independently.
• Bilingual (English/Spanish) communication skills.

• 4 weeks PTO + 10 paid holidays in the first year.
• Comprehensive benefits:
  Medical, Dental, Vision, Life, and Disability Insurance.
• Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP).
• Career growth:
  Internal training and advancement opportunities.
• Culture: A supportive, team‑based work environment.

• Quality claim handling – thorough investigations, strong documentation, well‑supported decisions.
• Compliance & audit performance – adherence to jurisdictional and client standards.
• Timeliness & accuracy – purposeful file movement and dependable execution.
• Client partnership – proactive communication and strong follow‑through.
• Professional judgment – owning outcomes and solving problems with integrity.
• Cultural alignment – treating each claim as a real person and acting accordingly.

Actual compensation will be based on qualifications, experience, geographic location, and internal equity. The role may also qualify for additional bonuses or pay.

• Visa Sponsorship: CCMSI does not provide visa sponsorship for this position.
• ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process.
• Equal Opportunity
  
  Employer:
  
  CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations.

• Lead with transparency – build trust by being open and listening.
• Perform with integrity – choose the right path, even when it is hard.
• Chase excellence – set a high bar and measure success.
• Own the outcome – treat every claim and decision as our own.
• Win together – support client success.