About this role
Astrana Health is a physician-centric, technology-enabled healthcare company built to deliver accessible, high-quality, high-value care. As our value-based membership has grown, so has the complexity and cost of specialty and drug-related utilization. This is a newly created, high-visibility role: Astrana's first dedicated pharmacy leader on the health plan/payer side, responsible for standing up a formal pharmacy function to manage drug utilization management (UM) and lead cost-of-care strategy across our specialty and provider-administered drug spend. This is a working director role. You will set pharmacy strategy and build the function, while also rolling up your sleeves on complex utilization management reviews and cost initiatives in the near term. It's an opportunity to build a pharmacy program from the ground up inside a fast-growing, physician-led organization and to directly influence patient outcomes and cost of care at scale. Lead and build out Astrana's pharmacy function, serving as the organization's first dedicated pharmacy leader for drug-related utilization management and clinical pharmacy strategy. Own end-to-end utilization management for provider-administered (J-code) and specialty drugs, including prior authorization review, clinical criteria, and appeals, while personally handling complex case reviews as a working director. Design and lead cost-of-care initiatives across biosimilar conversion, site-of-care optimization, dose optimization, white labeling, and Buy-and-Bill-to-Part D (B to D) conversion. Develop and manage specialty pharmacy contracting strategy, and direct appropriate volume to Astrana's own specialty pharmacy channel where clinically and financially appropriate. Partner with medical directors, care management, and network teams to build clinical pathways and formulary/UM criteria for high-cost specialty and infusion therapies. Build and maintain reporting and dashboards that track drug spend trends, savings initiatives, and UM turnaround-time performance for leadership. Collaborate cross-functionally with Health Services, Network Management, Finance, and Compliance to align pharmacy strategy with broader organizational goals. Monitor the regulatory and payer landscape (CMS, state Medicaid, health plan formularies) affecting specialty drug and UM requirements, and ensure programs remain compliant. Establish policies, workflows, and documentation standards for the pharmacy function, and help scope and build out the team as volume and scope grow.