Clinical Navigator (Remote)
Location
Baltimore, MD
Job Type
Full-time
Category
other-general
Posted
June 27, 2026
**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 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. 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, training or other business-related activities. The candidate's primary residence must be within the greater Baltimore metropolitan area. Bi...
**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 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. 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, training or other business-related activities. The candidate's primary residence must be within the greater Baltimore metropolitan area. Bi...