About the Role

Astrana Health is seeking a Part-Time Medical Director – Utilization Management, Outpatient Services to provide physician oversight for medical necessity, appropriateness, and utilization decisions across outpatient, ancillary, and professional services.

This role supports Astrana Health's delegated risk arrangements by ensuring compliant, evidence-based utilization while partnering closely with outpatient clinical leadership, utilization management operations, and health plan stakeholders.

Key Responsibilities

Utilization Management

Provide physician oversight and final determination for outpatient utilization management activities, including prior authorizations, retrospective reviews, and appeals.

Ensure the medical necessity and appropriateness of outpatient services, including specialty referrals, diagnostic testing, imaging, durable medical equipment (DME), therapies, and procedures.

Support compliance with delegated health plan requirements, regulatory standards, and accreditation guidelines.

Clinical Leadership

Conduct peer-to-peer reviews and provide physician education to improve documentation quality, guideline adherence, and appropriate utilization.

Partner with Outpatient Medical Directors, Population Health, and Utilization Management nursing teams to align utilization decisions with Astrana Health's value-based care strategy.

Identify outpatient utilization trends, care variation, and network leakage while recommending clinical strategies to improve quality outcomes and cost efficiency.

Serve as the clinical liaison with health plans and external vendors on outpatient utilization management matters.

Qualifications

The ideal candidate will have:

• MD or DO degree.
• Board Certification in Internal Medicine, Family Medicine, or a relevant outpatient specialty.
• An active, unrestricted California medical license.
• 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 primary care physicians and ambulatory specialists within value-based care models.
• Excellent physician-to-physician communication skills and sound clinical judgment.

Work Environment

This is a remote position open to candidates based in the United States.

Compensation

The national target base salary range for this position is $250,000–$325,000 USD, with final compensation determined by geographic location, experience, qualifications, and other job-related factors.

How to Apply

Submit your application through Astrana Health's careers portal.

Astrana Health is an Equal Employment Opportunity and Affirmative Action employer and welcomes qualified applicants from diverse backgrounds. Reasonable accommodations are available throughout the recruitment process for applicants with disabilities.

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