Maryland Licensed Clinical Navigator

Job Summary

To ensure members receive appropriate inpatient care, the full-time Maryland Licensed Clinical Navigator will manage utilization reviews, coordinate discharge planning, and collaborate with healthcare teams, primarily working remotely with occasional in-office meetings required for training and discussions.

Key responsibilities

• Utilize clinical expertise to evaluate medical necessity and support discharge planning for inpatient care
• Collaborate with medical directors and hospital teams to determine appropriate levels of care and improve member experiences
• Make referrals to care management programs for chronic and long-term care coordination as needed

Required qualifications

• Bachelor's Degree in Nursing or equivalent experience (4 additional years in relevant work)
• Active RN licensure in Maryland, Virginia, or Washington, DC
• Minimum of 5 years of clinically related experience in Utilization Review, Care Management, or Home Health
• Experience with utilization review in a healthcare payor organization is preferred
• Bilingual in Spanish is a plus