Remote RN: Care Transitions & Discharge Navigator

CareFirst, Inc.; Baltimore (MD); Hybrid; USD 72,000 - 144,000; Full time

Job summary

CareFirst, Inc. is seeking a Clinical Navigator (RN) to conduct inpatient level of care reviews and guide timely transitions to home or other care levels.

The role uses MCG guidelines and regulatory considerations to determine medical necessity and engage members, families, and support systems in discharge planning. The candidate should have RN licensure in MD/VA/DC and 5 years of related care management experience, with ability to work remotely from the Baltimore area and travel to CareFirst

Qualifications

• RN with MD/VA/DC licensure or equivalent nursing qualifications.
• Bachelor's Degree in Nursing required; additional experience acceptable in lieu of degree.
• Minimum 5 years of clinically related experience in care management, discharge coordination or utilization review.

Responsibilities

• Analyze EMRs, benefit contracts, and policies to determine inpatient service necessity and authorization.
• Telephonically engage with members, families and providers for discharge planning and care coordination.
• Collaborate with medical directors and participate in case rounds to determine appropriate level of care.
• Refer to other care management programs as appropriate and work with hospital teams to improve member experience.

Skills

Interpersonal skills

Clinical documentation

EMR knowledge

Analytical thinking

Regulatory knowledge

Microsoft Office

Time management

Customer service

Education

Bachelor's Degree in Nursing

RN licensure in MD/VA/DC

Tools

EMR systems

Microsoft Word

Microsoft Excel

PowerPoint

Job description

CareFirst, Inc. is seeking a Clinical Navigator (RN) to conduct inpatient level of care reviews and guide timely transitions to home or other care levels.

The role uses MCG guidelines and regulatory considerations to determine medical necessity and engage members, families, and support systems in discharge planning. The candidate should have RN licensure in MD/VA/DC and 5 years of related care management experience, with ability to work remotely from the Baltimore area and travel to CareFirst