Part-Time Utilization Review Nurse (Remote Nevada RN)

Ccmsi•Carson City, NV

23d•$40,000 - $45,000•Remote

About The Position

At CCMSI, we don't just process claims—we support people. As one of the largest employee-owned Third Party Administrators in the nation and a certified Great Place to Work®, we offer meaningful work, manageable caseloads, and a culture where your expertise matters. As an employee-owner, you'll directly contribute to our success and share in it too. We're seeking a Part-Time Utilization Review Nurse to conduct medical necessity reviews for treatment requests related to workers' compensation claims. This role is fully remote (Nevada-based) and ideal for a nurse who thrives in a structured, detail-driven environment and enjoys applying clinical judgment to ensure quality, appropriate care. You will review provider-submitted treatment requests, apply evidence-based guidelines, and issue determinations in accordance with Nevada's utilization review standards.

Requirements

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.

Nice To Haves

Experience in trauma, orthopedics, occupational medicine, rehab therapy, med-surg, or workers' compensation.
Exceptional organizational skills and the ability to work independently.

Responsibilities

Utilization Review concerns the quality of care provided to injured employees, including whether the service is appropriate and effective and the quality of treatment.
Appropriate service is health care service that is medically necessary and reasonable, and based on objective, clinical findings.
Pursuant to the NAC 616C.123 (1), the criteria or guidelines used in the UR Plan, are consistent with the ACOEM Practice guidelines adopted as standards for the provision of accident benefits to employees who have suffered industrial injuries or occupational diseases.
Other Medical Criteria utilized include but are not limited to: Official Disability Guidelines The Medical Disability Guidelines NCM/UR shall use the Guidelines as minimum standards for evaluating and ensuring the quality of programs of treatment provided the injured employee who is entitled to accident benefits.
Reports the diagnosis, ICD 9 code, medical appropriateness of the service, pertinent physical findings, diagnostic and therapeutic procedures, concurrent problems, follow‑up care and the injured employee's functional limitations.
Authorize a determination based on the health care service request reviewed; based on the information provided, meets or does not meet the clinical requirements for medical necessity and reasonableness of said service in accordance with appropriate medical guidelines.
The UR reviewer will process requests in accordance with the timelines specified in Nevada Revised Statute and Nevada Administrative Code.