About the role

Provide clinical oversight and leadership in utilization review operations at Astrana Health. Ensure that members receive high-quality, appropriate, and cost-effective care.

Responsibilities

Provide clinical oversight and strategic leadership through our utilization review operations to ensure members receive high-quality, medically appropriate, and cost-effective care.
You'll work closely with teams in Care Management, Quality Improvement, Pharmacy, Behavioral Health, and Compliance to drive aligned decision-making that supports both optimal patient outcomes and efficient healthcare resource use.
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.
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.

Medical Degree (MD or DO) from an accredited institution; active and unrestricted medical license in CA.
Board certification (preferred) in a relevant specialty (e.g., Internal Medicine, Family Medicine, or equivalent).
Minimum 5+ years of clinical practice experience.
At least 3 years of experience in utilization management or medical management within a health plan, IPA/MSO, or risk-bearing organization.
Deep knowledge of managed care, value-based care, capitation, and CMS/Medi-Cal guidelines.
Proficient in applying MCG, InterQual, or equivalent criteria.
Strong understanding of state and federal regulations (e.g., CMS, DMHC, NCQA).
Excellent communication skills, including the ability to engage providers in meaningful, respectful clinical dialogue.
Highly collaborative mindset with a commitment to improving healthcare equity, quality, and cost-effectiveness.

This position operates on a hybrid schedule out of our Monterey Park office, located at 1600 Corporate Center Drive. We are seeking candidate who reside in Southern California who are able to go in-office for orientation, meetings, etc.
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 **[email protected]** 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.