---
title: 'Utilization Management Lead — Inpatient Case Management (RN) at Akido'
canonical: 'https://feeny.ai/job/utilization-management-lead-inpatient-case-management-rn-akido-chino-hills-h0c24w14jymr'
type: 'job'
last_seen: '2026-11-11'
---

# Utilization Management Lead — Inpatient Case Management (RN) at Akido

- **Company:** Akido
- **Location:** Chino Hills, CA
- **Compensation:** $103k–$130k
- **Posted:** 2026-11-10
- **Last confirmed live:** 2026-11-11
- **Apply:** https://job-boards.greenhouse.io/akidolabs/jobs/4728753006

## 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 Utilization Management Lead, Inpatient Case Management, is responsible for leading Akido's inpatient case management function across three pillars: inpatient status determination, transitions of care, and complex case management. This is a hands-on role. The Lead reviews and determines status for delegated inpatient and SNF admissions, owns post-discharge transitions for members leaving those facilities, and carries the complex case management caseload for high-risk members, including direct member and caregiver outreach. As the program moves past its current MVP, the Lead will refine stratification, outreach, and documentation standards, operationalize admission and discharge notification workflows, and build the team structure needed to scale as membership grows. The role sits within the Utilization Management department in a California managed care environment, reports to the UM Manager, and works closely with the Medical Director, PCPs, facilities, health plan partners, and operational teams. This is a hybrid position.

## What you'll do

Pillar 1: Inpatient status determination

- Perform initial admission and concurrent review for delegated inpatient and SNF admissions using MCG and health plan criteria, and determine appropriate status and level of care
- Prepare clinical summaries and route cases that do not meet criteria to the Medical Director for determination within required timeframes
- Coordinate with facility case managers on continued stay, discharge readiness, and post-acute placement
- Document reviews, determinations, and rationale in EZCap and maintain compliance with notification and turnaround requirements

Pillar 2: Transitions of care

- Own post-discharge follow-up for members discharged from inpatient and skilled nursing facilities: respond to admission and discharge notifications, complete outreach and medication reconciliation, and coordinate follow-up visits within required timeframes
- Operationalize the ADT/TCM notification feed: define which events trigger outreach, set response timeframes and escalation paths, and validate notifications against facility admissions
- Coordinate discharge planning with hospital and SNF case managers, home health, DME, and PCP offices to prevent avoidable readmissions

Pillar 3: Complex case management and member outreach

- Carry the complex case management caseload for high-risk members: identify and enroll eligible members, complete comprehensive assessments, and develop individualized, patient-centered care plans in collaboration with the Medical Director and treating providers
- Lead interdisciplinary care team coordination for medically and psychosocially complex populations, ensuring evidence-based care plans are delivered and updated
- Conduct ongoing member and caregiver outreach, medication review and reconciliation, and coordination of specialist, ancillary, and community resources, documenting time and activities
- Define and apply case closure criteria and transition members to lower-intensity care management when appropriate

Program scale and compliance

- Scale the program past MVP: refine risk stratification and enrollment criteria, outreach cadence, care plan standards, documentation requirements, and closure criteria
- Finalize and maintain the policies and procedures required for delegated inpatient review and complex case management, and keep case files audit-ready
- Prepare for and support health plan audits, and produce the monthly and quarterly transitions of care and case management reports owed to health plans
- Maintain compliance with CMS, DMHC, and health plan delegation standards, including timeliness, notification, and documentation requirements

Leadership and team building

- Report program performance to the UM Manager and Medical Director, and recommend workflow changes based on the data
- Build the team structure as the program scales: define roles, caseload distribution, and coverage model; coach, train, and onboard case management staff added as membership grows
- Partner with UM nurses and coordinators, Claims, Eligibility, Network, and Operations to resolve member and provider issues
- Serve as the clinical point of contact for health plan care management partners and for PCPs across Akido clinics and the contracted network

## Who you are

- Active, unrestricted California RN license (required)
- 5+ years of clinical experience, including 3+ years combined in inpatient utilization management and complex case management in a managed care, IPA, MSO, or health plan setting
- Working knowledge of MCG criteria and inpatient status determination
- Experience with transitions of care, discharge planning, and post-acute coordination for Medicare Advantage or similar populations
- Experience building or scaling a care management program, or demonstrated ownership of program-level outcomes (preferred)
- Certified Case Manager (CCM) or equivalent certification (preferred)
- Experience in a delegated MSO or health plan environment, including preparation for delegation audits (preferred)
- Working knowledge of CMS and DMHC requirements for delegated UM and case management, HEDIS Transitions of Care measures, and readmission drivers
- Experience with EZCap or comparable managed care systems (preferred)
- Strong clinical assessment and care planning skills, with attention to documentation quality
- Comfortable with data: able to read program reports, spot trends, and use them to adjust workflows
- Effective written and verbal communication with members, providers, health plan partners, and leadership
- Ability to manage competing priorities and fixed regulatory timeframes in a fast-paced environment
- Bilingual English/Spanish (preferred)

Salary range $103,000—$130,000 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)

## Other roles at Akido

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