Developer

The Complex Care RN (CCM RN) at Alignment Health serves as a key clinical leader within a virtual care pod, managing high-acuity Medicare Advantage members' care journeys through coordination, monitoring, and proactive engagement to improve health outcomes.

Location: Remote (Jamaica)

Salary: $79,697.00 - $119,545.00

Responsibilities

• Own the Member Journey and Care Coordination for High-Acuity 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 Guideline-Directed Care Delivery.
• Document All Clinical Interactions Accurately and Timely in Athena.

Requirements

• Minimum 3 years of clinical RN experience in complex care, care management, transitions of care, case management, palliative care/hospice, acute care, or a related clinical setting.
• Demonstrated experience managing medically complex, high-risk patient populations including chronic disease management, medication reconciliation, and care transition coordination.
• Prior experience in a Medicare Advantage, managed care, home-based care, or value-based care environment with working knowledge of HEDIS, HCC coding, and care gap management.
• Experience working in a telehealth or virtual care delivery model with proficiency in virtual member engagement and remote clinical monitoring.
• Demonstrated ability to coordinate care across multiple disciplines and communicate effectively with clinical and non-clinical team members.