Virtual Complex Care RN — Senior Patient Navigator

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

Job summary

Alignment Health is seeking a Complex Care RN (CCM RN) to lead the member journey for high-acuity Medicare Advantage members in a fully virtual care pod. You will coordinate care across disciplines, perform medication reconciliation, monitor clinical status, and support APCs, Health Coaches, and Social Workers to keep members engaged and safe.

This role emphasizes care transitions, proactive outreach, and documentation in Athena, with an emphasis on HEDIS and quality measure closure.

Qualifications

• Minimum 3 years of RN experience in complex care, transitions of care, or related field.
• Experience in Medicare Advantage or value-based care models is preferred.
• Telehealth or virtual care delivery experience is required or strongly preferred.

Responsibilities

• Own the member journey and care coordination for high-acuity Medicare Advantage members.
• Manage transitions of care and hospital discharge coordination.
• Complete medication reconciliations and clinical monitoring.
• Escalate clinical concerns and support APC clinical decision-making.
• Facilitate cross-disciplinary care coordination across the pod.
• Support HEDIS, quality, and care gap closure.
• Manage chronic condition care pathways and GDMT alignment.
• Document all interactions timely in the EMR.

Skills

Complex Care Coordination

Telehealth Engagement

Care Transition Coordination

Clinical Documentation

HEDIS Knowledge

Education

ADN/BSN preferred

Tools

Athena EMR

TalkDesk

Job description

Alignment Health is seeking a Complex Care RN (CCM RN) to lead the member journey for high-acuity Medicare Advantage members in a fully virtual care pod. You will coordinate care across disciplines, perform medication reconciliation, monitor clinical status, and support APCs, Health Coaches, and Social Workers to keep members engaged and safe.

This role emphasizes care transitions, proactive outreach, and documentation in Athena, with an emphasis on HEDIS and quality measure closure.