Kapolei, Hawaii, 96707
Job description
**Job Title: Nurse Reviewer**
The Nurse Reviewer assesses medical necessity standards to evaluate the validity of inpatient hospital admissions and oversees services to enhance quality care while achieving cost-effective results. This role also involves reviewing claims for medical necessity, detecting potential quality concerns, and working closely with internal teams and healthcare providers to maintain compliance with regulations. Applicants should possess an Associate Degree in Nursing and hold a valid RN or LPN license in Hawaii without restrictions. A minimum of two years of experience in clinical care or case management is essential, accompanied by excellent organizational, communication, and critical thinking abilities.
HMSA provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
