Virtual Complex Care RN — Senior Health Navigator

Alignment Healthcare USA, LLC; Fresno (CA); On-site; USD 86,000 - 129,000; Full time

Job summary

Alignment Health is seeking a Complex Care RN for Fresno, CA to manage care for high-risk Medicare Advantage members in a virtual care model. You will coordinate transitions of care, perform medication reconciliations, and collaborate with interdisciplinary teams to optimize outcomes.

Requirements include 3+ years in complex care, CA RN license, and experience with Medicare Advantage or value-based care; BSN preferred and CCM certification a plus.

Qualifications

• RN with 3+ years in complex care or related clinical settings
• Experience with Medicare Advantage or value-based care environments
• Telehealth/virtual care experience is preferred
• Knowledge of HEDIS, HCC coding, care gap management
• Active, unrestricted RN license in CA; BLS
• BSN or higher preferred; CCM certification is a plus

Responsibilities

• Manage and coordinate care for medically complex Medicare Advantage members
• Build relationships with members and caregivers through virtual engagement
• Lead transitions of care after hospital or SNF discharge
• Perform medication reconciliations and monitor clinical status
• Identify and escalate clinical concerns to providers
• Collaborate with multidisciplinary teams for seamless care
• Support chronic disease management for heart failure, COPD, diabetes, CKD
• Participate in HEDIS and care gap closure activities
• Maintain accurate documentation in Athena EMR

Skills

RN experience

Chronic disease management

Telehealth/virtual care

HEDIS knowledge

Care coordination

Communication

Education

Associate Degree in Nursing

BSN (preferred)

Tools

Athena EMR

TalkDesk

Job description

Alignment Health is seeking a Complex Care RN for Fresno, CA to manage care for high-risk Medicare Advantage members in a virtual care model. You will coordinate transitions of care, perform medication reconciliations, and collaborate with interdisciplinary teams to optimize outcomes.

Requirements include 3+ years in complex care, CA RN license, and experience with Medicare Advantage or value-based care; BSN preferred and CCM certification a plus.