Remote Complex Care RN — Telehealth Case Management

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

Job summary

Alignment Health is seeking a Complex Care RN (CCM RN) to own the member journey and coordinate care for high-acuity Medicare Advantage members in a fully virtual delivery model. You will work with a pod that includes APCs, Health Coaches, Care Coordinators, and Social Workers to ensure timely, proactive care.

The ideal candidate has 3+ years of RN experience in complex care, familiarity with Medicare Advantage, HEDIS, and care gap management, and strong telehealth skills.

Qualifications

• Minimum 3 years of RN experience in complex care, care management, or transitions of care.
• Experience with Medicare Advantage, HEDIS, and care gap management.
• Telehealth or virtual care delivery experience required.
• Strong communication and cross-disciplinary collaboration skills.

Responsibilities

• Own the member journey and care coordination for high-acuity Medicare Advantage members.
• Coordinate care across PCPs, APCs, Health Coaches, and Social Workers.
• Conduct telehealth outreach and monitor clinical status.
• Perform medication reconciliations and post-discharge follow-up.
• Escalate clinical concerns and support provider-level decisions.

Skills

Telehealth experience

Care coordination

Virtual member engagement

Multidisciplinary collaboration

Excellent communication

Education

Associate Degree in Nursing (ADN)

BSN preferred

RN license active in applicable state(s)

Case Management Certification (CCM) or equivalent

Tools

Athena EMR

TalkDesk

Job description

Alignment Health is seeking a Complex Care RN (CCM RN) to own the member journey and coordinate care for high-acuity Medicare Advantage members in a fully virtual delivery model. You will work with a pod that includes APCs, Health Coaches, Care Coordinators, and Social Workers to ensure timely, proactive care.

The ideal candidate has 3+ years of RN experience in complex care, familiarity with Medicare Advantage, HEDIS, and care gap management, and strong telehealth skills.