Provide clinical oversight and strategic leadership through our utilization review operations to ensure members receive high-quality, medically appropriate, and cost-effective care.
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.
Apply evidence-based criteria to utilization decisions, mentor clinical review teams, and support compliance with all applicable regulatory and contractual obligations.

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.
The national target base salary range for this role is: $275,000
$325,000. Actual compensation will be determined based on geographic location (current or future), experience, or other job-related factors.
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 humanresourcesdept@astranahealth.com to request an accommodation.

Medical Director – Utilization Management

Key skills