Maryland Licensed Clinical Navigator

Job Summary

To facilitate smooth transitions from inpatient care, the full-time Maryland Licensed Clinical Navigator will conduct concurrent reviews, manage discharge planning, and collaborate with hospital teams remotely while leveraging clinical expertise and care management skills.

Key responsibilities

• Conduct concurrent reviews of inpatient care to determine medical necessity and appropriate levels of care
• Engage with members, families, and providers to develop discharge plans and address barriers to care
• Collaborate with hospital care teams and CareFirst medical directors to ensure optimal member experiences and outcomes

Required qualifications

• Bachelor's Degree in Nursing or 4 additional years of relevant work experience in lieu of a degree
• 5 years of clinically related experience in Care Management, Home Health, Discharge Coordination, or Utilization Review
• Active RN licensure in Maryland, Virginia, or Washington, DC
• Knowledge and experience with MCG guidelines
• Experience with Commercial and Federal Employee Program (FEP) benefits contracts