Nurse Case Manager Senior

• →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

 

 

• 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

 

• 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

Why You’ll Love Working Here

 

• 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

 

How We Measure Success 

 

 

At CCMSI, successful Nurse Case Managers stand out through:

• Quality clinical assessments and recommendations
• Effective utilization review decisions
• Positive return-to-work outcomes
• Appropriate medical management and treatment coordination
• Cost-effective claim resolution
• Strong documentation and reporting
• Client and stakeholder satisfaction
• Compliance with clinical and regulatory requirements

 

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. 

 

 

 

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