Care Management Specialist

4 days ago


Baltimore, Maryland, United States CareFirst Full time

**Job Description:**

We are seeking a skilled Care Management Specialist to join our team at CareFirst. The successful candidate will be responsible for determining medical necessity, appropriate level of care, and referrals to case management.

Key Responsibilities:

  • Collaborate with healthcare professionals to determine medical necessity and appropriate level of care
  • Engage members/enrollees, their families, and other support systems in discharge planning
  • Analyze available clinical information, electronic medical records (EMRs), benefit contracts, mandates, medical policy, evidence-based published research, national accreditation, and regulatory requirements

Requirements:

  • Bachelor's Degree, Nursing or equivalent experience
  • 5 years clinically related experience working in Care Management, Home Health, Discharge Coordination, and/or Utilization Review
  • Strong communication and interpersonal skills
  • Proficiency in web-based technology and Microsoft Office applications

Benefits:

  • Competitive salary range: $85,000 - $110,000 per year
  • Ongoing training and professional development opportunities
  • Comprehensive benefits package


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