Maryland Licensed Clinical Navigator

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