Part-Time Utilization Review Nurse – Remote (Nevada License Required)

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

Bring Your Nursing Expertise to a Flexible, Part-Time Role at CCMSI

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 their success.

We don’t just process claims—we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work®, and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day.

Job Summary

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.

• 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.

Qualifications (Required)

• 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 Have

• 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) communications skills - This role may involve communicating with injured workers, employers, or vendors where Spanish-language skills are beneficial but not required.

Why You’ll Love Working Here

• 4 weeks PTO + 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

How We Measure Success

At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by:

• 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 – believing every claim represents a real person and acting accordingly 

This is where we shine, and we hire nurses who want to shine with us.

Compensation & Compliance

The posted salary reflects CCMSI’s good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of 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.

Our Core Values

At CCMSI, we believe in doing what’s right—for our clients, our coworkers, and ourselves. We look for team members who:

• Lead with transparency We build trust by being open and listening intently in every interaction.
• Perform with integrity We choose the right path, even when it is hard.
• Chase excellence We set the bar high and measure our success. What gets measured gets done.
• Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own.
• Win together Our greatest victories come when our clients succeed.

We don’t just work together—we grow together. If that sounds like your kind of workplace, we’d love to meet you.

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