Complex Care Registered Nurse, AZ license

The Complex Care RN (CCMRN) serves as the clinical center of the Care Anywhere pod, owning the member journey and coordinating care across disciplines to ensure the highest‑acuity Medicare Advantage members receive timely, proactive, and coordinated care in a fully virtual delivery model.

• Own the member journey and care coordination for an assigned panel of high‑risk Medicare Advantage members, maintaining consistent engagement cadence and proactively monitoring clinical status.
• Manage transitions of care for members discharged from hospitals, SNFs, and other inpatient settings, completing post‑discharge outreach, medication reconciliation, and follow‑up coordination to reduce avoidable readmissions.
• Conduct medication reconcilations, review medication lists for accuracy and adherence, identify potential interactions, and elevate findings to the APC as needed.
• Monitor symptom changes, lab values, and care gap alerts, and coordinate responses across the pod when abnormal findings require action.
• Serve as the first clinical escalation point, triaging member concerns, assessing urgency, and routing to the PCP, APC, or RMO for provider‑level intervention.
• Coordinate cross‑disciplinary care with PCPs, APCs, health coaches, care coordinators, social workers, and the RMO, ensuring each member’s care is cohesive and accountable.
• Participate in care gap closure activities, including outreach for abnormal labs, overdue preventive services, and HEDIS measure gaps, to meet quality performance targets.
• Proactively manage chronic conditions (e.g., heart failure, COPD, diabetes, CKD) through ongoing monitoring and structured care pathways, collaborating with the pod to optimize treatment plans.
• Document all clinical interactions, medication reconcilations, escalations, and care plan updates accurately and timely in Athena, supporting HCC coding and compliance.
• Work independently as a clinical expert with no direct reports; all formal people‑management matters are handled by the Manager of Clinical Operations.

• Minimum 3years of clinical RN experience, including direct patient care in complex or transition‑of‑care settings.
• Demonstrated experience managing medically complex, high‑risk patient populations with chronic disease management and medication reconciliation.
• Experience in a Medicare Advantage, managed‑care, or value‑based care environment with knowledge of HEDIS, HCC coding, and care‑gap management.
• Proficiency in a telehealth or virtual care delivery model, with virtual member engagement and remote clinical monitoring.
• Strong ability to coordinate care across multiple disciplines and communicate effectively with clinical and non‑clinical team members.
• Active, unrestricted RN license in the applicable state(s); multi‑state licensure preferred.
• BSN or higher preferred; associate degree in nursing (ADN) required.
• Case‑management certification (CCM) or equivalent credential preferred.
• Proficiency with Athena EMR and Talk Desk or equivalent virtual engagement platform preferred.
• Formal training in motivational interviewing, health coaching, or complex care management is an asset.
• Ability to perform essential physical functions as described: talk or hear, stand, walk, sit, use hand and finger to handle objects, lift up to 10lb.

Pay Range: $79,697.00 – $ (may vary by location, education, responsibilities, and experience).

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.