RN Clinical Navigator: Inpatient Discharge & Care Coordination

CareFirst BlueCross BlueShield; Baltimore (MD); On-site; USD 72,000 - 144,000; Full time

Job summary

CareFirst BlueCross BlueShield is seeking a Clinical Navigator (RN) to conduct concurrent review of inpatient care and manage transitions to home or other levels of care. The role uses MCG guidelines and engages telephonically with hospital teams, patients and families to optimize medical necessity and discharge planning.

Requirements include a Bachelor's in Nursing (or 4 extra years of related experience) and 5 years of clinically related work in care management, along with RN licensure in

Qualifications

• Bachelor's Degree in Nursing or, in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required.
• 5 years clinically related experience in Care Management, Home Health, Discharge Coordination and/or Utilization Review.
• RN license in MD, VA or Washington, DC (state licensure and/or compact)

Responsibilities

• Analyze clinical information, EMRs, contracts, mandates and policies to aid in determining appropriateness and authorization of inpatient services.
• Collaborate with CareFirst medical directors to determine the appropriate level of care and action plan.
• Make referrals to other care management programs for chronic and long-term care coordination.
• Work with hospital teams to develop positive relationships and improve the member experience.

Skills

Interpersonal skills

Clinical documentation

MS Office

Analytical skills

Knowledge of clinical guidelines

Education

Bachelor's Degree in Nursing

4 years of additional relevant work experience

Job description

CareFirst BlueCross BlueShield is seeking a Clinical Navigator (RN) to conduct concurrent review of inpatient care and manage transitions to home or other levels of care. The role uses MCG guidelines and engages telephonically with hospital teams, patients and families to optimize medical necessity and discharge planning.

Requirements include a Bachelor's in Nursing (or 4 extra years of related experience) and 5 years of clinically related work in care management, along with RN licensure in