Remote Complex Care RN (Must live in San Diego County)

Alignment Healthcare USA, LLC; San Diego (CA); Remote; USD 86,000 - 129,000; Full time

Job summary

Alignment Health is seeking a Complex Care RN to serve as the clinical quarterback for a panel of high-risk Medicare Advantage members, coordinating virtual care to ensure the right care at the right time and improve outcomes.

In our Care Anywhere model, you’ll collaborate with Advanced Practice Clinicians, Care Coordinators, Health Coaches and Social Workers to support chronic disease management, transitions of care, and quality initiatives while adhering to HEDIS guidelines.

Qualifications

• Registered nurse with at least 3 years in complex care or care management.
• Experience with Medicare Advantage, managed care, or value-based care.
• Knowledge of HEDIS, HCC coding, and care gap management.
• Experience in telehealth or virtual care settings.

Responsibilities

• Manage and coordinate care for medically complex Medicare Advantage members.
• Build trusted relationships with members and caregivers via virtual engagement.
• Lead transitions of care after hospital, SNF, or inpatient discharges.
• Complete medication reconciliations and monitor changes in status.
• Identify and escalate clinical concerns to the appropriate provider.
• Partner with multidisciplinary teams to ensure seamless care.
• Support chronic disease management for heart failure, COPD, diabetes, CKD.
• Assist with HEDIS, quality initiatives, and care gap closure.
• Maintain accurate, timely documentation in Athena EMR.

Skills

RN Experience

Telehealth

Care Coordination

Bilingual English/Spanish

HEDIS knowledge

HCC knowledge

Education

ADN

BSN preferred

RN license in CA

CCM certification

Tools

Athena EMR

TalkDesk

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.Are you passionate about helping medically complex patients navigate their healthcare journey? At Alignment Health, we're transforming healthcare for seniors through coordinated, value-based care. As a Complex Care RN, you'll serve as the clinical quarterback for a panel of high-risk Medicare Advantage members, helping ensure they receive the right care at the right time while improving outcomes and quality of life.***Location Requirement: Candidates must reside in San Diego County to be considered.***Language Requirement: Bilingual in Spanish & English (Read, Write, Speak) is preferred.Working within our innovative Care Anywhere model, you'll collaborate closely with Advanced Practice Clinicians, Care Coordinators, Health Coaches, Social Workers, and Primary Care Providers to deliver proactive, member-centered care in a virtual environment.What You'll DoManage and coordinate care for medically complex Medicare Advantage members.Build trusted relationships with members and caregivers through ongoing virtual engagement.Lead transitions of care following hospital, SNF, and inpatient discharges.Complete medication reconciliations and monitor changes in clinical status.Identify and escalate clinical concerns to the appropriate provider.Partner with multidisciplinary teams to ensure seamless, coordinated care.Support chronic disease management for conditions including heart failure, COPD, diabetes, and CKD.Assist with HEDIS, quality initiatives, and care gap closure activities.Maintain accurate, timely documentation in Athena EMR.What You BringRequiredLocated in the South Bay - San Diego, CA areaMinimum 3 years of RN experience in complex care, care management, case management, transitions of care, palliative care, hospice, acute care, or a related clinical setting.Experience managing medically complex, high-risk patient populations.Experience with chronic disease management, medication reconciliation, and care transition coordination.Experience in Medicare Advantage, managed care, home-based care, or value-based care environments.Knowledge of HEDIS, HCC coding, and care gap management.Experience working in telehealth or virtual care settings.Strong interdisciplinary care coordination and communication skills.Education & LicensureAssociate Degree in Nursing (ADN) required; BSN strongly preferred.Active, unrestricted RN license in CACurrent BLS certification.Preferred QualificationsBSN or higher.Certified Case Manager (CCM) certification.Multi-state RN licensure.Experience with Athena EMR and TalkDesk or similar virtual engagement platforms.Background in population health, care management programs, or Medicare case management.Bilingual English/SpanishWhy Join Alignment Health?Work at the top of your license supporting high-risk populations.Be part of an innovative care model transforming senior healthcare.Collaborate with a dedicated, multidisciplinary care team.Make a direct impact on reducing hospitalizations and improving member outcomes.Join a mission-driven organization focused on compassionate, coordinated careEssential Physical Functions:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.Pay Range: $85,696.00 - $128,543.00Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [e-mail].