Complex Care Registered Nurse, California RN License Required, Bilingual English/Spanish Preferred

🕒 July 16

🏄 California – Remote

🏄 California – Remote

💵 $85.7k - $128.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 45%

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 cadence and proactively monitor clinical status • Build trusted 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 as appropriate • Triage member clinical concerns and route them to the PCP, CAW APC, or RMO for provider-level intervention • Coordinate care across PCPs, APCs, Health Coaches, Care Coordinators, Social Workers, RMOs, caregivers, and external care partners • Facilitate HEDIS care gap closure, preventive care reminders, abnormal lab follow-up, and member education • Manage chronic condition care pathways for heart failure, COPD, diabetes, CKD, and other high-risk comorbidities • Support guideline-directed medical therapy, treatment-plan optimization, medication adherence, symptom management, and lifestyle education • Maintain updated care plans and coordinate follow-up on labs, diagnostics, and specialty care • Document clinical interactions, care coordination, medication reconciliations, escalations, and care plan updates accurately and timely in Athena • Support HCC coding accuracy, care continuity, CMS compliance, and organizational standards • Perform other duties and projects as assigned • Work as an individual contributor with no direct reports or supervisory authority

🎯 Requirements

• California residents only • Active, unrestricted Registered Nurse (RN) license in California required • Current BLS certification required • Associate Degree in Nursing (ADN) required; BSN strongly preferred • 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, including chronic disease management, medication reconciliation, and care transition coordination • Experience in Medicare Advantage, managed care, home-based care, or value-based care, with working knowledge of HEDIS, HCC coding, and care gap management • Experience in telehealth or virtual care delivery, with proficiency in virtual member engagement and remote clinical monitoring • Ability to coordinate care across multiple disciplines and communicate effectively with clinical and non-clinical team members • Demonstrated proficiency with telehealth delivery platforms • Working knowledge of Medicare Advantage benefits, care coordination protocols, and transitions of care standards • Advanced complex care coordination and member journey management • Advanced transitions of care and medication reconciliation • Advanced clinical assessment and escalation judgment • Advanced telehealth and virtual member engagement • Advanced Athena EMR and clinical documentation • Advanced cross-disciplinary communication and pod collaboration • Intermediate HEDIS and quality measure awareness • Bilingual English/Spanish preferred • Athena EMR and TalkDesk or equivalent virtual engagement platform preferred • Multi-state licensure, BSN or higher, CCM certification, ACLS certification, and formal training in motivational interviewing, health coaching, complex care management, HEDIS documentation, quality measures, or transitions of care preferred

🏖️ Benefits

• Fully remote work model • Opportunity for growth and innovation • Bilingual English/Spanish preferred • Equal Opportunity/Affirmative Action Employer