Complex Care RN — Virtual Care Navigator

Alignment Health; United States; Remote; USD 86,000 - 129,000; Full time

Job summary

Alignment Health is seeking a Complex Care RN to manage a panel of Medicare Advantage members in a virtual care model from Fresno, CA. You will coordinate care, perform medication reconciliations, and lead transitions of care with a multidisciplinary team.

Based in the Care Anywhere program, you will collaborate with Advanced Practice Clinicians, Care Coordinators, Health Coaches, Social Workers, and PCPs to deliver proactive member-centered care in a virtual environment and to optimize HEDIS

Qualifications

• RN with complex care or transitions of care experience.
• Experience with Medicare Advantage, HEDIS, and care gaps.
• Telehealth/virtual care experience preferred.

Responsibilities

• Coordinate care for medically complex Medicare Advantage members.
• Lead transitions of care post-discharge and perform med reconciliations.
• Collaborate with interdisciplinary teams to ensure care continuity.
• Document accurately in Athena EMR and support quality initiatives.
• Identify and escalate clinical concerns to providers.

Skills

RN experience

Telehealth/virtual care

Care coordination

Medicare Advantage knowledge

HEDIS/HCC coding

Bilingual English/Spanish

CA RN license

Communication skills

Education

ADN

BSN preferred

CA RN license

BLS certification

Tools

Athena EMR

TalkDesk

Job description

Alignment Health is seeking a Complex Care RN to manage a panel of Medicare Advantage members in a virtual care model from Fresno, CA. You will coordinate care, perform medication reconciliations, and lead transitions of care with a multidisciplinary team.

Based in the Care Anywhere program, you will collaborate with Advanced Practice Clinicians, Care Coordinators, Health Coaches, Social Workers, and PCPs to deliver proactive member-centered care in a virtual environment and to optimize HEDIS