Clinical Review Nurse - Complex Case Management and Prior-Authorization
Akido · Chino, California
Posted 4 days ago
or apply directly on Akido's site. We never take the application ourselves.
Is this posting real?
- This role has been open
- 4 days Akido's roles stay open a median of 30 days
- Reposted
- No
- Salary listed
- No 0% of Akido's roles list one
- Ghost-job risk at Akido
- high 5 stale, 1 reposted of 14 open
- Hiring momentum
- 26 roles opened in the last 90 days ↑ up vs. the prior 90 days
- Last confirmed on the employer's board
- 2026-09-17
Measured from postings appearing on and disappearing from Akido's own greenhouse board since 2026-08-03. Full hiring picture for Akido.
About this role
The Clinical Review Nurse will primarily focus on reviewing and processing prior authorization requests to ensure they meet medical necessity and compliance standards. This role also involves supporting complex case management for high-risk members, collaborating with healthcare providers, and maintaining accurate documentation of clinical determinations and care plans.
- benefits
- 1/5
- freshness
- 5/5
- career value
- 3/5
- role clarity
- 4/5
- pay transparency
- 0/5
Scored from the posting itself — how clearly the role is described, how much it says about pay and benefits, and how recently it was listed. Not a judgement of Akido as an employer.
What you need
- Active California RN license
- 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
- Strong clinical assessment skills and attention to detail
Nice to have
- Experience with EZCap
- Experience in a delegated MSO or health plan environment
- Certified Case Manager (CCM) preferred
- Knowledge of California managed care regulations (DMHC/CMS)
Worth weighing
- Salary range provided is $62,400 — $93,600 USD
- Role is primarily focused on prior authorization review with secondary responsibilities in case management, which may limit exposure to broader clinical practices
- Experience with EZCap is preferred but not required, which could impact onboarding for those unfamiliar with the system
Summarised from Akido's posting. Read the full original.
Listed by Akido on their greenhouse job board, last confirmed open on 2026-09-17. PitchMeAI is not the employer.
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