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.
STEMHUNTER is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, sexual orientation, gender identity, and gender expression), national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law. We comply with all applicable equal employment opportunity and affirmative action regulations.
