Inpatient Utilization Lead — Case Management

Akido Labs, Inc.; Chino Hills (CA); On-site; USD 103,000 - 130,000; Full time

Benefits offered by this job

Equal opportunity employer

Job summary

Akido Labs, Inc. in California is seeking an Utilization Management Lead, Inpatient Case Management, to oversee inpatient status determinations, transitions of care, and complex case management across our network.

This hands‑on role reports to the UM Manager, collaborates with the Medical Director, PCPs, facilities, and health plan partners, and requires CA RN license and 5+ years of relevant experience; bilingual English/Spanish preferred.

Qualifications

• Active, unrestricted California RN license is required.
• 5+ years of clinical experience, including inpatient utilization management and complex case management.
• Experience with CMS/DMHC requirements for delegated UM and case management is preferred.

Responsibilities

• Lead inpatient status determination for delegated inpatient and SNF admissions.
• Own transitions of care and post‑discharge follow‑up for high‑risk members.
• Manage complex case management caseload and develop individualized care plans in collaboration with medical directors and providers.
• Define and maintain escalation paths, documentation standards, and closure criteria.
• Scale program operations, maintain audit-ready case files, and support health plan audits.

Skills

RN license

Clinical experience

Bilingual English/Spanish (preferred)

Education

CCM certification (preferred)

Tools

EZCap

Job description

Akido Labs, Inc. in California is seeking an Utilization Management Lead, Inpatient Case Management, to oversee inpatient status determinations, transitions of care, and complex case management across our network.

This hands‑on role reports to the UM Manager, collaborates with the Medical Director, PCPs, facilities, and health plan partners, and requires CA RN license and 5+ years of relevant experience; bilingual English/Spanish preferred.