Maryland Licensed Clinical Navigator

Job Summary

To facilitate smooth transitions from inpatient care, the full-time Maryland Licensed Clinical Navigator will conduct concurrent reviews, collaborate with hospital teams, and ensure appropriate levels of care while working remotely with occasional in-office meetings.

Key responsibilities

• Analyze clinical information and engage with members and providers to coordinate discharge planning and care transitions
• Collaborate with medical directors and participate in case discussions to determine the appropriate level of care
• Make referrals to care management programs for chronic and long-term care coordination

Required qualifications

• Bachelor's Degree in Registered Nursing or 4 years of relevant experience in lieu of a degree
• Active RN licensure in Maryland, Virginia, or Washington, DC
• 5 years of clinically related experience in an acute care setting or Utilization Review
• Knowledge and experience with MCG guidelines
• Experience with Medicare/Medicaid enrollees and benefits contracts