Clinical Navigator (Remote)

**Resp & Qualifications**

**PURPOSE:**
The Clinical Navigator (RN) conducts concurrent review of inpatient level of care, managing the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and skills in both care management and utilization management, the Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care, and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working telephonically with the hospital care team including case managers, social workers and discharge planners to ensure CareFirst members/enrollees receive the appropriate level of care and partner to address any potential barriers to discharge. The candidate may be required to come to the CareFirst office location periodically for meetings, tr...