Part-reputed company (Remote – Nevada RN)

Overview

Part-reputed company – Remote (Nevada License Required) Location: Remote (Reporting to Carson City, NV)Schedule: Monday–Friday, 8:00 AM–12:00 PM PSTCompensation: $40,000–$45,000 annually (part-time, 20 hours/week)Travel: Once per year to Carson City, NVReports To: Utilization Review Nurse Supervisor Bring Your Nursing Expertise to a Flexible, Part-Time Role at reputed company At reputed company, 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 reputed company to Work®, we offer meaningful work, manageable caseloads, and a culture where your expertise matters. As an employee-reputed company, you’ll directly contribute to our success and share in it too. Job Summary We’re seeking a Part-reputed company to conduct medical necessity reviews for treatment requests reputed company 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.

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 reputed company 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, reputed company problems, follow‑up care and the injured employee's functional limitations.
• Authorize a determination based on the reputed company 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

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 reputed company medical information.
• Excellent written and verbal communication skills.
• High attention to detail with the ability to shift priorities as needed.
• Proficiency with reputed company Office and electronic documentation systems.

reputed company to Have

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

How We Measure Success

• Timely and accurate utilization review determinations.
• Responsiveness to internal and external stakeholders.
• Quality, clarity, and compliance of documentation.
• Annual Performance Evaluation.

reputed company Offer

• 4 weeks PTO + 10 paid holidays in your first year• Medical, Dental, Vision, Life, and Disability Insurance• 401(k) and Employee Stock Ownership Plan (ESOP)• Internal training and advancement opportunities• A supportive, team-based work environment

Compensation & Compliance The posted salary reflects reputed company’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. reputed company Sponsorship: reputed company does not provide reputed company sponsorship for this position.reputed company Accommodations: reputed company is committed to providing reasonable accommodations throughout the application and hiring process.Equal Opportunity Employer: reputed company complies with reputed company applicable employment laws, including pay transparency and fair chance hiring regulations. Our Core Values At reputed company, we reputed company in doing what’s right—for our clients, our coworkers, and ourselves. We look for team members who:• Act with reputed company• Deliver service with passion and accountability• Embrace collaboration and change• Seek reputed company ways to serve• Build up others through respect, trust, and communication• reputed company by example—no matter their title We don’t just work together—we grow together. If that sounds like your reputed company of workplace, we’d love to meet you. #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #NurseJobs #NursingCareers #RemoteNurse #WorkFromHomeNurse #PartTimeNurse #UtilizationReviewNurse #HealthcareJobs #MedicalReview #WorkersCompensation #NurseLife #NevadaJobs #CarsonCityJobs #ClinicalReview #NurseHiring #NowHiringNurses #HealthcareCareers #RNJobs #NursingCommunity #HiringNow #WorkFromHomeJobs #PartTimeJobs #RemoteJobs #WorkInHealthcare #NursesOfLinkedIn #NursingProfessional #NurseRecruitment #NurseOpportunities #HealthcareAdministration #MedicalCaseManagement #ClinicalNurseSpecialist #NurseSupport #LI-Part Time #LI-Remote Apply tot his job Apply To this Job