Nurse Case Manager Senior

Ccmsi • Carson City, NV

9d • Remote

About The Position

The Senior Nurse Case Manager is responsible for providing medical case management and utilization review services for a dedicated Nevada Workers' Compensation program. This role serves as a clinical resource to claims professionals, injured workers, employers, and medical providers, while promoting quality care, appropriate treatment, cost-effective medical management, and timely return-to-work outcomes. The successful candidate will manage a caseload of approximately 30 medical-only Workers' Compensation claims, while also performing utilization review activities and providing clinical guidance on treatment plans, medical necessity, and evidence-based care recommendations. This position is ideal for an experienced Registered Nurse who combines strong clinical knowledge with Workers' Compensation, utilization review, and case management expertise. Candidates with utilization review experience are strongly encouraged to apply, and case management experience is preferred.

Requirements

• Current Registered Nurse (RN) license required
• Nevada nursing license required, or ability to obtain and maintain Nevada licensure
• Previous Nurse Case Management experience required
• Utilization Review experience required
• Strong knowledge of medical terminology, treatment planning, and clinical documentation review
• Experience reviewing medical records and determining medical necessity
• Strong written and verbal communication skills
• Ability to collaborate effectively with medical providers, adjusters, employers, and injured workers
• Excellent organizational, time-management, and documentation skills
• Ability to work independently in a remote environment
• Proficiency with Microsoft Office applications, including Outlook, Word, and Excel
• Reliable attendance during established business hours

Nice To Haves

• Workers' Compensation Nurse Case Management experience
• Utilization Review certification or designation
• Experience using ODG Guidelines
• BSN preferred
• Clinical background in one or more of the following: Orthopedics, Occupational Medicine, Medical-Surgical Nursing, Rehabilitation, Trauma Care
• Government program experience
• CCM or other case management certifications

Responsibilities

• Manage medical-only Workers' Compensation cases through the case management process
• Conduct utilization review activities in accordance with Nevada regulations, clinical guidelines, and program requirements
• Review medical records, treatment plans, provider recommendations, and clinical documentation
• Assess medical necessity, appropriateness of care, and treatment progress
• Develop and document individualized case management action plans
• Collaborate with adjusters, providers, employers, and injured workers to support positive claim outcomes
• Monitor treatment progress and identify opportunities to facilitate return-to-work and maximum medical improvement
• Provide recommendations regarding treatment options, specialty referrals, second opinions, independent medical evaluations, and other medical services
• Support adjusters with clinical insight regarding treatment plans, diagnoses, and medical management strategies
• Maintain accurate documentation and timely case management reporting
• Assist with provider resource development and clinical education efforts when needed
• Promote cost-effective treatment while ensuring quality care and compliance with program standards
• Maintain compliance with applicable regulations, clinical standards, and CCMSI service expectations

Benefits

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your 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

What This Job Offers

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