Utilizing experience and skills in both care management and utilization management, the Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/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.