Medical Director Utilization Management (Part-Time or Full-Time)
Job Location:
Job Location:
Monterey Park, NM - USA
Yearly Salary:
$ 275000 - 315000
Yearly Salary:
Posted on:
30+ days ago
Posted on:
Vacancies:
1 Vacancy
Vacancies:
Job Summary
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 youll 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:
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 Youll 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 peertopeer 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 Astranas valuebased 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 UMrelated 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 valuebased care models.
- Strong physiciantophysician 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: $275000 - $325000. 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 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.
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.
Required Experience:
Director
