---
title: 'Clinical Review Nurse - Complex Case Management and Prior-Authorization at Akido'
canonical: 'https://feeny.ai/job/clinical-review-nurse-complex-case-management-and-prior-authorization-akido-w8javt3c6fen'
type: 'job'
last_seen: '2026-09-16'
---

# Clinical Review Nurse - Complex Case Management and Prior-Authorization at Akido

- **Company:** Akido
- **Location:** Chino, CA
- **Compensation:** $62k–$94k
- **Posted:** 2026-09-12
- **Last confirmed live:** 2026-09-16
- **Apply:** https://job-boards.greenhouse.io/akidolabs/jobs/4712961006

## Job description

Akido builds AI-powered doctors. Akido is the first AI-native care provider, combining cutting-edge technology with a nationwide medical network to address America’s physician shortage and make exceptional healthcare universal. Its AI empowers doctors to deliver faster, more accurate, and more compassionate care.

Serving 500K+ patients across California, Rhode Island, and New York, Akido offers primary and specialty care in 26 specialties—from serving [unhoused communities](https://www.fastcompany.com/91231274/how-one-la-doctor-is-using-ai-to-help-homeless-communities-get-medical-care) in Los Angeles to [ride-share drivers](https://www.wsj.com/articles/the-ai-doctor-will-see-new-york-ride-share-drivers-now-5ba53e6c?mod=Searchresults_pos1&page=1) in New York.

Founded in 2015 (YC W15), Akido is expanding its risk-bearing care models and scaling ScopeAI, its breakthrough clinical AI platform. [Read more about Akido’s $60M Series B](https://www.businesswire.com/news/home/20250515102298/en/Akido-Raises-%2460-Million-Series-B-to-Expand-Reach-of-ScopeAI-its-Breakthrough-Health-Artificial-Intelligence). More info at [Akidolabs.com](http://Akidolabs.com).

The Opportunity

- The Clinical Review Nurse – Complex Case Management and Prior-Authorization is responsible for reviewing and processing prior authorization requests to ensure medical necessity, appropriate level of care, and compliance with health plan and regulatory requirements, as well as supporting complex case management for members with ongoing or high-risk care needs. This role is primarily focused on prior authorization review, with secondary responsibility for complex case management as the program grows within the Utilization Management (UM) department, and it supports delegated UM operations in a California managed care environment. The Clinical Review Nurse works closely with providers, Medical Directors, and operational teams to ensure timely and accurate authorization determinations in accordance with established clinical guidelines and delegation standards.

## What you’ll do

- Review and process prior authorizations for outpatient services, procedures, diagnostic testing, specialty referrals, and DME and ancillary services
- Evaluate requests using MCG guidelines and health plan criteria and policies
- Review medical records and supporting clinical documentation to ensure completeness, accuracy, and medical necessity in accordance with established clinical guidelines and health plan requirements
- Identify missing or insufficient documentation and coordinate with providers for additional information
- Support case management for members with complex or high-risk care needs, including care coordination and follow-up
- Ensure all clinical determinations are properly documented in the system
- Maintain compliance with DMHC prior authorization requirements, CMS guidelines, health plan delegation standards, turnaround times, notification requirements, and documentation standards
- Communicate with physicians, medical groups, facilities, and ancillary providers to obtain additional clinical information and provide authorization status updates as needed
- Identify cases requiring clinical review and prepare clinical summaries for Medical Director determination
- Ensure cases requiring denial are routed appropriately to the Medical Director
- Document all authorization activities accurately within EZCap, maintaining detailed notes, status updates, and decision rationale
- Collaborate with UM Coordinators, Claims, Eligibility, and Operations
- Conduct comprehensive assessments and contribute to development of patient-centered care plans in collaboration with Medical Director
- Perform monthly care management outreach, medication review, and specialist/community resource coordination, documenting time and activities

## Who you are

- Active California RN license (required)
- 3-5+ years of current clinical UM review
- Experience with prior authorization in managed care or delegated environment
- Experience with complex case management
- Knowledge of MCG criteria, medical necessity review, and prior authorization workflows
- Experience with EZCap (preferred)
- Experience in a delegated MSO or health plan environment (preferred)
- Certified Case Manager (CCM) preferred
- Knowledge of California managed care regulations (DMHC/CMS)
- Strong clinical assessment skills and attention to detail
- Effective written and verbal communication
- Ability to manage competing priorities in a fast-paced environment

Salary range $62,400—$93,600 USD

Akido Labs, Inc. is an equal opportunity employer, and we encourage qualified applicants of every background, ability, and life experience to contact us about appropriate employment opportunities.

## About Akido

## Company Overview
- **One-liner**: Akido Labs builds AI-powered clinical software and operates a nationwide network of primary and specialty care clinics to make exceptional healthcare universal.
- **Entity Type**: Private (Series B, Y Combinator W15)
- **Headquarters**: Los Angeles, California, United States
- **Founded**: 2015
- **Founders**: Prashant Samant (CEO) and Jared Goodner

## Core Business
- **Primary industry**: Healthcare technology and healthcare services (AI-native care delivery)
- **Target customers**: B2C (patients) and B2B (health plans, risk-bearing entities); serves underserved populations, unhoused communities, and ride-share drivers
- **Mission statement**: “We intend to even the playing field, leveraging AI and the latest medical advancements to bring the dream of high-quality personalized care to all. We are building the future of healthcare for everyone.” [akidolabs.com](https://www.akidolabs.com/)

## Products & Services
- **Scope AI** – A proprietary clinical AI operating system trained on a large health data corpus, designed to assist doctors across all specialties, enabling hyper-personalized care and population health management. [akidolabs.com](https://www.akidolabs.com/)
- **Akido Care Network** – A nationwide medical network (96 locations, 245+ providers) offering primary and specialty care across 26 specialties, with next-day visits and house calls. Serves 500,000+ patients. [akidolabs.com](https://www.akidolabs.com/)
- **Insurance / Risk-Bearing Models** – Tailored health plans covering life, disability, mental health, medical reimbursement, and accident insurance (mentioned in LinkedIn profile). [linkedin.com](https://www.linkedin.com/company/akido-labs)

## Market Standing
- **Valuation**: Not publicly disclosed
- **Key Metric**: Total funding – **$81.6M** across 7 rounds, including a **$60M Series B** led by Oak HC/FT (June 2025) and an $11.2M Series A led by Future Communities Capital (December 2020). [linkedin.com](https://www.linkedin.com/company/akido-labs)
- **Annual Revenue**: Estimated at **$18.3M** (LinkedIn data, likely conservative for a startup at scale). [linkedin.com](https://www.linkedin.com/company/akido-labs)
- **Notable Investors/Partners**: Oak HC/FT, Future Communities Capital, Y Combinator; leadership includes former National COO of Kaiser Permanente and former President of Anthem Blue Cross (California). [akidolabs.com](https://www.akidolabs.com/company)
- **Growth Signals**:
  - Headcount growth of **141.8% year-over-year** (LinkedIn reports 107 employees, though website claims “1000+ people around the world” – likely includes clinicians and contractors). [linkedin.com](https://www.linkedin.com/company/akido-labs) | [akidolabs.com](https://www.akidolabs.com/)
  - Serving 500K+ patients across California, Rhode Island, and New York
  - 620,000 patient visits per year
  - Expanding risk-bearing care models and scaling Scope AI nationally [akidolabs.com](https://www.akidolabs.com/)

## Competitive Advantages
- **First AI-native care provider** – Combines proprietary AI (Scope AI) with a real-world clinic network, creating a closed-loop data flywheel.
- **Deep integration with social impact** – Street medicine programs for unhoused populations and safety net partnerships differentiate Akido from pure telehealth or traditional providers.
- **Experienced leadership** – Team includes former hospital administrators, health plan executives, and AI researchers from USC Digital Health Lab.
- **Speed and accessibility** – Next-day visits, house calls, $44 average copay (vs. 26-day wait times and 2-hour waits in traditional settings). [akidolabs.com](https://www.akidolabs.com/)

## Strategic Focus
- **Scale Scope AI** – Bring the AI platform to patients across the U.S. starting with Akido Care, aiming for “AI to unlock healthcare super-abundance provided by humans.”
- **Expand risk-bearing contracts** – Grow the IPA (Independent Practice Association) and value-based care arrangements to reduce costs and improve outcomes.
- **Geographic expansion** – Currently in California, Rhode Island, and New York; plans to enter more states.
- **Talent acquisition** – Active hiring for clinical, operations, product, and engineering roles (20+ open positions as of mid-2025). [greenhouse.io](https://job-boards.greenhouse.io/akidolabs)

## Why Work Here
- **Mission-driven**: “Make excellent healthcare a basic human right” – employees report high culture scores (4.4/5 on LinkedIn, 4.4 for culture, 4.2 for career). [linkedin.com](https://www.linkedin.com/company/akido-labs)
- **AI + healthcare impact**: Opportunity to work on cutting-edge AI applied directly to patient outcomes, with a strong engineering and product team (27% of 107 employees in technical roles).
- **Diverse roles**: Positions range from street medicine clinicians and operations managers to software engineers and product designers; some remote/hybrid options (e.g., Part-Time Registered Dietitian in New York with possible remote). [greenhouse.io](https://job-boards.greenhouse.io/akidolabs)
- **Compensation**: Transparent salary ranges for some roles (e.g., Software Engineer ~$140K, Senior Software Engineer ~$161K). [linkedin.com](https://www.linkedin.com/company/akido-labs)
- **Culture**: “Bridging Technology & Empathy” – team spans 5 countries, with a flat hierarchy and emphasis on social equity.

## Sources
1. [akidolabs.com](https://www.akidolabs.com/) – Company homepage, mission, product details  
2. [akidolabs.com/company](https://www.akidolabs.com/company) – Leadership, 1000+ people claim, history  
3. [linkedin.com/company/akido-labs](https://www.linkedin.com/company/akido-labs) – Employee count, funding, revenue, reviews, recent news  
4. [job-boards.greenhouse.io/akidolabs](https://job-boards.greenhouse.io/akidolabs) – Open positions, job descriptions  
5. [wellfound.com/company/akido-labs](https://wellfound.com/company/akido-labs) – (Note: not explicitly given but referenced via YC W15 status in search results – used for Y Combinator affiliation)

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- [Clinical Systems Training & Support Specialist](https://feeny.ai/job/clinical-systems-training-support-specialist-akido-ri-c299kz9efbe6) — , RI
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