CareFirst jobs

Sr. Operations Clinical Review Analyst

Resp & QualificationsPURPOSE:This position handles day to day reviews and adjudicates professional and institutional claims and inquiries that require individual clinical consideration, medical necessity, or medical appropriateness review for proper claims processing and/or adjudication. This includes interpretation and application of Clinical Medical Review departmental policies, corporate policies, clinical information, member and provider contracts, Maryland, Virginia and District o...

Navigator, Community Health (DC Medicaid)

Resp & QualificationsPURPOSE:Working as a bridge between the member, clinical and administrative staff, the Navigator helps members, families, and caregivers access the health care delivery system through outreach, follow-up, coordination support, education, communication, and resources.ESSENTIAL FUNCTIONS:Act as a liaison to ensure members are connected with appropriate care channels (i.e. pharmacy, insurance, billing, referral) and have the information they need to successfully navig...

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