Complex Care Registered Nurse – Bilingual English/Spanish, Active CA RN License Required

🕒 July 16

🏄 California – Remote

🏄 California – Remote

💵 $85.7k - $128.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 30%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

🛡️ Insurance

🏥 Healthcare

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• Serve as the primary care coordinator for an assigned panel of medically complex, high-risk Medicare Advantage members • Maintain consistent member engagement, proactively monitor clinical status, and coordinate care across the care pod • Build relationships with members and caregivers through regular telehealth outreach • Manage transitions of care from hospitals, SNFs, and other inpatient settings • Complete post-discharge outreach, medication reconciliation, follow-up coordination, and care-plan updates • Monitor symptoms, lab values, and care-gap alerts; escalate clinical findings to APCs and providers • Triage clinical concerns and support APC clinical decision-making • Coordinate with PCPs, APCs, Health Coaches, Care Coordinators, Social Workers, RMO, caregivers, and external care partners • Support HEDIS, quality performance, preventive-care, and care-gap closure activities • Manage chronic-condition care pathways for heart failure, COPD, diabetes, CKD, and other high-risk comorbidities • Reinforce chronic-disease education, medication adherence, symptom management, lifestyle modifications, and escalation triggers • Document all clinical interactions, care coordination, reconciliations, escalations, and care-plan updates accurately and timely in Athena • Perform other duties and projects as assigned • Individual contributor with no direct reports or supervisory authority

🎯 Requirements

• Minimum 3 years of clinical RN experience in complex care, care management, transitions of care, case management, palliative care/hospice, acute care, or related clinical setting • Experience managing medically complex, high-risk patient populations • Experience with chronic disease management, medication reconciliation, and care transition coordination • Experience in Medicare Advantage, managed care, home-based care, or value-based care • Working knowledge of HEDIS, HCC coding, and care gap management • Experience in telehealth or virtual care delivery and remote clinical monitoring • Ability to coordinate care across multiple disciplines • Bilingual English/Spanish • Associate Degree in Nursing (ADN) required; BSN strongly preferred • Active, unrestricted Registered Nurse (RN) license in applicable state(s) • Current BLS certification • Demonstrated proficiency with telehealth delivery platforms • Working knowledge of Medicare Advantage benefits, care coordination protocols, and transitions of care standards • Reside in South Bay San Diego (Chula Vista, National City, or San Ysidro) • Athena EMR and TalkDesk or equivalent virtual engagement platform preferred • Case Management Certification (CCM), multi-state licensure, ACLS certification, and formal specialized training preferred

🏖️ Benefits

• Fully remote work model • Opportunity for growth and innovation • Equal Opportunity/Affirmative Action employment