Teams at Alignment Healthcare

Remote RN Case Manager providing telephonic care coordination for complex, chronically ill seniors. Conducts comprehensive assessments, develops and implements care plans with PCPs and specialists, facilitates referrals/authorizations, provides education and self-management support, closes gaps in care, resolves provider/claims issues, documents care, and maintains PHI confidentiality.

Handle escalated member disenrollment requests and related quality assurance for Medicare managed care members. Resolve complex member issues, conduct inbound/outbound calls, document outcomes, collaborate with internal departments and vendors, support training, and ensure compliance with CMS and regulatory guidelines.

The Resolution Specialist resolves healthcare insurance claims, manages member issues, and collaborates with departments to improve service delivery and member satisfaction.