Nurse Reviewer: Clinical Precertification & UM

A healthcare insurance provider is seeking a Nurse Reviewer to utilize medical necessity criteria for precertification determinations and ensure compliance with clinical guidelines. The role requires strong organizational and communication skills, a current Nursing License in Hawaii, and two years of clinical or management experience. Responsibilities include evaluating treatment requests, documenting reviews, and consulting with Medical Directors as needed. This position is vital in maintaining healthcare quality and ensuring appropriate patient services are facilitated.
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