**Resp & Qualifications**

**PURPOSE:**

The Post- Acute Care Clinical Navigator (RN) manages 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 including proficiency in established MCG guidelines to determine medical necessity, appropriate level 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 telephonically (occasional weekend work may be required) 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 also be required to come to the CareFirst office location periodically for meetings, training, or other business-related activities. The candidate's primary res...