Remote Optum Utilization Review Jobs in Reno, NV

Schedule: Monday – Friday, 8:00 AM – 4:30 PM (PST)
Salary Range: $90,000 – $100,000 annually

At CCMSI, we partner with clients to solve complex risk management challenges through innovative claim solutions, collaborative problem-solving, and an unwavering commitment to service excellence.

As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim management solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work® and an employee-owned company where every employee has the opportunity to make a meaningful impact.

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.

• 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 

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.

CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents.

CCMSI posts internal career opportunities in compliance with applicable state and local promotion transparency laws.

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.

Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws.

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.