Alignment Health·California
The Complex Care RN coordinates the member journey for high-acuity Medicare Advantage members within a virtual care pod. Key duties include managing transitions of care, performing medication reconciliations, and escalating clinical concerns to providers.
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail.
It takes an entire team of passionate and caring people, united in our mission to put the senior first.
We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve.
In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community.
Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them.
Together.
The Complex Care RN (CCM RN) serves as the clinical center of the Care Anywhere pod — owning the member journey, coordinating care across disciplines, and ensuring the highest-acuity Medicare Advantage members receive timely, proactive, and coordinated care in a fully virtual delivery model. Embedded within a team-based pod alongside APCs, Health Coaches, Care Coordinators, Medical Assistants, and Social Workers, the CCM RN manages transitions of care, drives member engagement cadence, escalates clinical concerns, and serves as the central coordination point for all caregivers involved in a member’s care. This role is critical to the approved virtual health model because the CCM RN directly enables APCs to work at the top of their license — handling the coordination, monitoring, and transition work that would otherwise consume APC time — and ensures the organization’s most vulnerable members never fall through the cracks.
Own the Member Journey and Care Coordination for High-Acuity Members. Serve as the primary care coordinator for an assigned panel of medically complex, high-risk Medicare Advantage members — maintaining consistent engagement cadence, proactively monitoring clinical status, and ensuring all care activities across the pod are connected and moving forward. Build trusted relationships with members and their caregivers through regular telehealth outreach — identifying changes in condition, barriers to care, and social needs that require intervention.
Manage Transitions of Care and Hospital Discharge Coordination. Own transitions of care for members discharging from hospitals, SNFs, and other inpatient settings — completing timely post-discharge outreach, medication reconciliation, and follow-up coordination to reduce avoidable readmissions and support safe, effective transitions back to the community. Ensure all members’ care plans are updated following transitions and that all pod team members have the clinical context needed to support the member.
Complete Medication Reconciliations and Clinical Monitoring. Conduct medication reconciliations for assigned members — reviewing medication lists for accuracy, appropriateness, and adherence, identifying potential interactions or concerns, and escalating clinical findings to the APC as appropriate. Monitor for symptom changes, lab values, and care gap alerts — facilitating outreach and coordinating responses across the pod when abnormal findings require action.
Escalate Clinical Concerns and Support APC Clinical Decision-Making. Serve as the first clinical escalation point within the pod — triaging member clinical concerns, assessing urgency, and routing to the members PCP, CAW APC or RMO for provider-level intervention when needed. During virtual visits and between encounters, maintain situational awareness of member health status and proactively flag emerging clinical risks before they require emergency intervention.
Facilitate Cross-Disciplinary Care Coordination Across the Pod. Coordinate seamlessly with the members PCP, APCs, Health Coaches, Care Coordinators, Social Workers, and the RMO to ensure each member's care is cohesive and accountable across every role in the pod. Serve as the central communication point for caregivers — ensuring updates, care plan changes, and clinical concerns are shared promptly and accurately with all pod members and external care partners.
Support HEDIS, Quality, and Care Gap Closure. Participate in care gap closure activities — facilitating outreach for abnormal lab values, overdue preventive services, and HEDIS measure gaps in coordination with the Care Coordinator and APC. Support the pod's quality performance targets by ensuring members receive timely follow-up, preventive care reminders, and education that closes documented care gaps.
Manage Chronic Condition Care Pathways and Guideline-Directed Care Delivery.
Document All Clinical Interactions Accurately and Timely in Athena. Maintain accurate, complete, and timely documentation of all member interactions, care coordination activities, medication reconciliations, escalations, and care plan updates in Athena within established timeframes. Ensure documentation supports HCC coding accuracy, care continuity, and compliance with CMS and organizational standards.
Other duties and projects not listed above
This role is an individual contributor with no direct reports or supervisory authority. The CCM RN leads through clinical expertise and care coordination within the pod — all formal people management matters are owned by the Manager, Clinical Operations.
Minimum 3 years of clinical RN experience — with direct patient care 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
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
$85,696.00 - $128,543.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/ [https://protect-us.mimecast.com/s/P1GaC82l6KF8ygOUngCFQ/]. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com [careers@ahcusa.com].
Market context
California nursing roles often draw steady demand, especially for experienced RNs in procedural and critical care settings. Competition is strongest for candidates who already hold a California RN license, current BLS and ACLS, and recent ICU, ER, or PACU experience. Review the AI-summarized requirements and benefits on this platform to save research time, then confirm your certifications and highlight relevant bedside and procedural experience in your application.
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