Resp & Qualifications
The NICU/Peds 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 case management and utilization management including proficiency in established 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 (onsite at a health system in Baltimore and 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. Candidate's primary residence within the greater Baltimore Metropolitan area. The candidate may also be required to come to the CareFirst office location periodically for meetings, training or other business-related activities.
Education Level: Bachelor's Degree in Nursing OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Licenses/Certifications Upon Hire Required:
RN - Registered Nurse - Active State Licensure And/or Compact State Licensure RN- Registered Nurse in MD, VA or Washington, DC.
Experience: 5 years clinically related experience working in Care Management, Home Health, Discharge Coordination and/or Utilization Review.
Knowledge, Skills and Abilities (KSAs)
Salary Range: $69,768 - $138,567
Travel Requirements: Travel to assigned hospital or CareFirst locations.
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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