More jobs:
Clinical Precertification Nurse
Job in
Kapolei, Honolulu County, Hawaii, 96709, USA
Listed on 2026-08-26
Listing for:
HMSA
Full Time
position Listed on 2026-08-26
Job specializations:
-
Nursing
Healthcare Nursing
Job Description & How to Apply Below
HMSA in Hawaii seeks a Nurse Reviewer to render precertification determinations using medical necessity criteria and established policies. You will assess whether services are covered, clinically appropriate, or require Medical Director review, and collaborate with providers to obtain information.
You will follow CMS, NCQA, HSAG requirements, document outcomes, handle urgent and non-urgent requests, review services from inpatient to genetic testing, and coordinate with integrated health
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