Inpatient Utilization & Transitions Lead

Akido Companies Internal Job Board; Chino Hills (CA); In loco; USD 103.000 - 130.000; Tempo pieno

Descrizione del lavoro

Akido is seeking an Inpatient Utilization Management Lead to drive inpatient case management across admission status, transitions of care, and complex case management. You will own post-discharge coordination, review processes, and documentation to ensure timely, compliant patient care in a managed care environment.

You will lead a team, refine workflows, and build scalable processes as membership grows, collaborating with Medical Director, PCPs, facilities, and health plan partners.

Competenze

• 5+ years of clinical experience, including inpatient utilization management and complex case management
• Familiarity with CMS and DMHC requirements for delegated UM
• Experience with transitions of care, discharge planning, and post-acute coordination
• Experience building or scaling a care management program (preferred)
• Strong documentation and data-driven workflow skills (preferred)

Mansioni

• Lead inpatient utilization management across admission, status determination, and transitions of care
• Coordinate with facilities on continued stay, discharge readiness, and post-acute placement
• Manage complex case management caseload for high-risk members with multidisciplinary collaboration
• Develop and refine policies, workflows, and documentation standards; support audits and regulatory compliance

Conoscenze

Inpatient utilization management

Complex case management

Care coordination

Documentation quality

CMS/DMHC requirements

EZCap experience

Formazione

Certified Case Manager (CCM) certification

Descrizione del lavoro

Akido is seeking an Inpatient Utilization Management Lead to drive inpatient case management across admission status, transitions of care, and complex case management. You will own post-discharge coordination, review processes, and documentation to ensure timely, compliant patient care in a managed care environment.

You will lead a team, refine workflows, and build scalable processes as membership grows, collaborating with Medical Director, PCPs, facilities, and health plan partners.