Utilizing experience and skills in both care management and utilization management, the Clinical Navigator will leverage proficiency in established MCG, in addition to administrative and regulatory considerations, to determine medical necessity, appropriate levels 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, working telephonically 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.