Maryland Licensed Clinical Navigator
Job Summary
Working remotely within the greater Baltimore metropolitan area, the full-time Maryland Licensed Clinical Navigator will conduct concurrent reviews of inpatient care, manage transitions to home or other care levels, and collaborate with healthcare teams to ensure appropriate care for members.
Key responsibilities
- Utilize clinical expertise to analyze clinical information and engage with members and providers for effective discharge planning
- Collaborate with medical directors and participate in case discussions to determine appropriate care levels
- Make referrals to care management programs for chronic and long-term care coordination
Required qualifications
- Bachelor's Degree in Nursing or equivalent experience (4 additional years in relevant work)
- Active RN license in Maryland, Virginia, or Washington, DC
- Five years of clinically related experience in Care Management, Home Health, Discharge Coordination, or Utilization Review
- Direct experience with utilization review in a healthcare payor organization preferred
- Knowledge of MCG and experience with Medicare/Medicaid benefits contracts is advantageous
Complete Job Description
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