About this role
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 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.