Inpatient UM Lead: Transitions & Complex Care

Akido GmbH; Chino Hills (CA); Presencial; USD 103.000 - 130.000; Jornada completa

Descripción de la vacante

Akido Labs, Inc. is seeking an experienced Utilization Management Lead to oversee inpatient case management across three pillars: inpatient status, transitions of care, and complex case management. This hands-on role reports to the UM Manager and partners with Medical Director, PCPs, facilities, and health plan teams.

The role focuses on reviewing admissions, coordinating discharge planning, and expanding the program as membership grows, while maintaining CMS/DMHC standards and audit readiness.

Formación

• 5+ years of clinical experience in inpatient utilization management and complex case management in managed care.
• Experience with transitions of care and post-acute coordination for Medicare Advantage or similar populations.
• Familiarity with CMS/DMHC requirements for delegated UM and case management.

Responsabilidades

• Perform initial admission and concurrent review for delegated inpatient and SNF admissions using criteria and determine status and level of care.
• Prepare clinical summaries and route cases for Medical Director determination when needed.
• Coordinate with facility case managers on continued stay, discharge readiness, and post-acute placement.
• Document reviews and rationale in EZCap and ensure regulatory notification timelines are met.
• Lead post-discharge follow-up and manage transitions of care to prevent readmissions.
• Build and scale the program, refine risk stratification, and support audits and reporting.

Conocimientos

Utilization management

Inpatient care

Transitions of care

Complex case management

Team leadership

Stakeholder communication

CMS/DMHC knowledge

Data review & reporting

Educación

Certified Case Manager (CCM)

Herramientas

EZCap

Descripción del empleo

Akido Labs, Inc. is seeking an experienced Utilization Management Lead to oversee inpatient case management across three pillars: inpatient status, transitions of care, and complex case management. This hands-on role reports to the UM Manager and partners with Medical Director, PCPs, facilities, and health plan teams.

The role focuses on reviewing admissions, coordinating discharge planning, and expanding the program as membership grows, while maintaining CMS/DMHC standards and audit readiness.