Founding Clinical Operations Lead

Approva; California, Northern (MO, KY); Hybrid; USD 180,000 - 230,000; Full time

Benefits offered by this job

Founder‑tier equity

Direct work with founder

Lead reviewer team

Healthcare benefits

Job summary

Approva is seeking a senior reviewer to own the reviewer console and screen every Case before submission. You will build the audit playbook against payer-specific medical necessity criteria and collaborate with ASC pre-cert teams during onboarding.

You will demo the product to prospective customers, capture denial reasons as training signals, and by month six shape and lead the reviewer team. Equity and founder-level collaboration accompany a high-seniority, customer-facing role.

Qualifications

• CPMA, CASCC, or equivalent certification with surgical coding experience.
• RN with five+ years of utilization-management or payer-side prior authorization experience.
• Eight+ years working prior auth and denials at a high-volume facility (ASC, surgical hospital, or large multi-specialty group).
• Bay Area-based or willing to come for working sessions monthly.

Responsibilities

• Own the reviewer console — every Case that comes through Approva crosses your screen before submission.
• Build the audit playbook against payer-specific medical necessity criteria.
• Lead onboarding and demos with prospective customers and ASC pre-cert teams.
• Capture denial reasons as training signals and define the reviewer team by month six.

Skills

Surgical coding

Prior authorization

Utilization management

Denials analysis

Education

CPMA / CASCC certification

RN with 5+ years experience

Job description

The senior reviewer who sees the first hundred Cases through.

The work.

You own the reviewer console — every Case that comes through Approva crosses your screen before submission. You build the audit playbook against payer‑specific medical necessity criteria. You sit alongside the first ASC pre‑cert teams during onboarding and run live demos with prospective customers. You capture every denial reason as training signal. By month six, you have defined the reviewer team Approva hires as volume grows — and you lead it.

Who you are.

• CPMA, CASCC, or equivalent certification with surgical coding experience. Or RN with five or more years of utilization‑management or payer‑side prior authorization experience.
• Eight or more years working prior auth and denials at a high‑volume facility — ASC, surgical hospital, or large multi‑specialty group.
• Comfortable in front of customers. The senior reviewer demos the product, not a salesperson.
• Comfortable with software. Approva is technical — you work daily with engineers, file tickets, and shape the product roadmap.
• Bay Area‑based or willing to come for working sessions monthly.

What you get.

• Founder‑tier equity. Specifics in conversation; this is an employee‑number‑one role.
• Direct work with the founder. No layer of managers between you and the product.
• The reviewer team you go on to lead.
• Cash compensation that reflects your seniority. Healthcare benefits.

How we hire.

A thirty‑minute call with the founder. Then a working session with a de‑identified Approva Case — we send you the chart, you review the assembled Packet, we discuss what you would change. If both sides are still in, terms in writing within a week.