Medical Director - Utilization Management (Part-Time or Full-Time)

Astrana is seeking a California-licensed Medical Director - Utilization (UM) to provide clinical oversight and strategic leadership through our utilization review operations to ensure members receive high-quality, medically appropriate, and cost-effective care. This is a critical, cross-functional role that bridges clinical expertise with operational execution across value-based care, capitated models, and delegated risk structures.
In this role, you’ll apply evidence-based criteria to utilization decisions, mentor clinical review teams, and support compliance with all applicable regulatory and contractual obligations. We are seeking candidates with extensive outpatient UM experience. 
  This position is ideal for a clinically grounded physician who thrives in a data-informed, team-based environment and is passionate about transforming how care is delivered in a risk-bearing, population health-focused ecosystem.

We are open to part-time (three full 8 hour shifts from 8 AM - 5 PM PST) or full-time (32+ hours per week).

Our Values:  

• Put Patients First  
• Empower Entrepreneurial Provider and Care Teams  
• Operate with Integrity & Excellence  
• Be Innovative  
• Work As One Team 

What You'll Do

• Provide physician oversight and final determination for outpatient utilization management activities, including prior authorizations, retrospective reviews, and appeals.
• Ensure medical necessity and appropriateness of outpatient services such as specialty referrals, diagnostics, imaging, DME, therapies, and procedures.
• Support compliance with delegated health plan requirements, regulatory standards, and accreditation guidelines.
• Conduct peer‑to‑peer reviews and outpatient physician education to improve documentation, guideline adherence, and appropriate utilization.
• Partner with Outpatient Medical Directors, Population Health, and UM nursing teams to align utilization decisions with Astrana’s value‑based care strategy.
• Identify outpatient utilization trends, leakage, and variation; recommend clinical strategies to improve cost efficiency and quality outcomes.
• Serve as clinical liaison with health plans and external vendors on outpatient UM‑related matters.

Qualifications

• MD or DO; Board Certified in Internal Medicine, Family Medicine, or a relevant outpatient specialty required.
• Active, unrestricted medical license (California required).
• Prior experience in outpatient utilization management, health plan medical management, or delegated risk environments.
• Strong understanding of outpatient medical necessity criteria, prior authorization workflows, and appeals processes.
• Experience working with PCPs and ambulatory specialists in value‑based care models.
• Strong physician‑to‑physician communication and clinical judgment.

Environmental Job Requirements and Working Conditions

• This is a remote position. The position will operate in Pacific Standard Time. 
• The national target base salary range for this role is: $275,000 - $325,000. Actual compensation will be determined based on geographic location (current or future), experience, or other job-related factors. Salary will be pro-rated based on agreed upon hours. 

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.

Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.