Virtual Complex Care RN – Medicare Advantage Specialist

Alignment Health; Modesto (CA); Remote; USD 86,000 - 129,000; Full time

Job summary

Alignment Health is seeking a Complex Care Coordination RN (CCM RN) to own the member journey for high-acuity Medicare Advantage members within a fully virtual pod. You will coordinate care across clinicians, conduct medication reconciliations, and ensure timely, proactive interventions through telehealth outreach.

Required: ADN with RN license and 3+ years in complex care or care management. BSN preferred and experience in telehealth, HEDIS, and care transitions.

Qualifications

• RN with direct patient care in complex care or care management.
• Experience with Medicare Advantage or value-based care environments is a plus.

Responsibilities

• Own the member journey and care coordination for high-acuity Medicare Advantage members.
• Manage transitions of care and hospital discharge coordination.
• Perform medication reconciliations and clinical monitoring.
• Escalate clinical concerns and support APC clinical decision-making.
• Coordinate cross-disciplinary care and communicate with pod members and partners.
• Support HEDIS, quality, and care gap closure activities.
• Manage chronic condition care pathways and guideline-directed care delivery.

Skills

Complex Care

Telehealth

Clinical Assessment

Care Coordination

Escalation Skills

Athena EMR

Cross-Disciplinary

HEDIS Knowledge

Patient Education

Education

Associate Degree in Nursing (ADN)

BSN preferred

Tools

Athena EMR

TalkDesk

Job description

Alignment Health is seeking a Complex Care Coordination RN (CCM RN) to own the member journey for high-acuity Medicare Advantage members within a fully virtual pod. You will coordinate care across clinicians, conduct medication reconciliations, and ensure timely, proactive interventions through telehealth outreach.

Required: ADN with RN license and 3+ years in complex care or care management. BSN preferred and experience in telehealth, HEDIS, and care transitions.