Virtual Complex Care RN: Senior Health Navigator

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

Job summary

Alignment Health USA, LLC is seeking an experienced CCM RN to lead care coordination for high-acuity Medicare Advantage members in a fully virtual pod. You will drive member engagement through telehealth and collaborate with APCs, nurses, and social workers to maintain care quality.

The role emphasizes transitions of care, medication reconciliation, and proactive risk management across multi-disciplinary teams in a remote, multi-market model.

Qualifications

• Experience in coordinating care for high-risk Medicare Advantage members.
• Telehealth/virtual care delivery proficiency with remote engagement.
• Athena EMR documentation and care coordination proficiency.

Responsibilities

• Own the member journey and care coordination for high-acuity members.
• Manage transitions of care and post-discharge coordination to reduce readmissions.
• Conduct medication reconciliations and monitor clinical indicators.
• Escalate clinical concerns and support APC/RMO decision-making.
• Coordinate cross-disciplinary care with PCPs, APCs, Health Coaches, and Social Workers.
• Support HEDIS, quality measures, and care-gap closure activities.
• Oversee chronic condition care pathways and GDMT adherence.
• Document all interactions accurately in Athena within required timeframes.

Skills

Complex Care Coordination

Telehealth

Athena EMR

HCC coding

Care Transitions

Multidisciplinary Collaboration

Education

ADN required

BSN preferred

CCM certification preferred

Tools

TalkDesk

Job description

Alignment Health USA, LLC is seeking an experienced CCM RN to lead care coordination for high-acuity Medicare Advantage members in a fully virtual pod. You will drive member engagement through telehealth and collaborate with APCs, nurses, and social workers to maintain care quality.

The role emphasizes transitions of care, medication reconciliation, and proactive risk management across multi-disciplinary teams in a remote, multi-market model.