Astrana Health

Medical Director

• 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.

Medical Director – Utilization Management

• Serve as physician leader for inpatient clinical operations across assigned hospitals.
• Drive quality, safety, and patient outcomes aligned with Astrana Health’s value‑based and capitated risk programs.
• Partner with hospitalists, specialists, nursing leadership, and case management to optimize LOS, avoidable utilization, and transitions of care.
• Oversee physician performance, clinical compliance, and adherence to evidence‑based protocols and pathways.
• Collaborate with Population Health, Utilization Management, and Post‑Acute teams to reduce readmissions and total cost of care.
• Support payer and delegated risk requirements, including clinical documentation, medical necessity, and audits.
• Act as clinical liaison between Astrana Health, hospital partners, and community physicians.

Inpatient Medical Director – SoCal

General Counsel

• Draft, review, and negotiate a high volume of healthcare‑related agreements, including:
• Plan‑to‑plan and other payer agreements
• Provider participation and network contracts
• Value‑based, shared savings, and risk‑sharing arrangements
• MSO, IPA, and delegated risk agreements
• Vendor and strategic partnership agreements
• Data sharing agreements and BAAs
• Independently lead some contract negotiations with minimal oversight
• Provide pragmatic, business‑oriented legal guidance that enables execution
• Partner closely with stakeholders across:
• Network Development
• Contracting
• Operations
• Finance
• Compliance; and
• Executive Leadership
• Help structure complex arrangements that balance growth, operational realities, and legal risk
• Identify potential legal and regulatory issues early and propose actionable solutions
• Support informed, well‑documented risk decisions aligned with company priorities and regulatory guardrails.
• Advise on California managed care and healthcare regulatory considerations
• Support innovative and evolving value‑based care and risk‑bearing structures
• Help navigate delegated care and risk arrangements
• Provide guidance on contract terms that materially impact operational execution
• Collaborate closely with Compliance on regulatory interpretation and escalation
• Develop and refine templates, playbooks, and negotiation frameworks
• Improve contracting workflows, consistency, and turnaround time
• Identify opportunities and means to streamline legal processes

Senior Counsel, Managed Care Operations

Medical Billing and Coding

• Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company.
• Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC).
• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines.
• Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.
• Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing.
• Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
• Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
• Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
• Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
• May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I.
• Other duties as assigned.

Risk Adjustment Coding Specialist II

• 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.

Data Engineer

• Lead and mentor a team of data engineers, fostering a culture of continuous learning, innovation, and operational excellence.
• Partner with cross-functional teams to design and implement scalable data pipelines and models aligned with business needs and industry best practices.
• Oversee the development, deployment, and maintenance of enterprise-grade ELT processes, data marts, and business intelligence assets.
• Own and evolve data quality frameworks, ensuring proactive monitoring, troubleshooting, and resolution of data issues.
• Champion the adoption of automation and modern data engineering practices, driving efficiencies in pipeline management and data delivery.
• Guide your team in building domain knowledge around healthcare operations, ensuring data solutions comply with regulatory and security requirements.
• Contribute to strategic planning for the data engineering function, including resource allocation, technology selection, and process improvement initiatives.
• Support and enforce software development best practices, including code reviews, source control, CI/CD, and testing.

Manager – Data Engineering

Business Intelligence Analyst

• Assist in the preparation and review of internal and external financial statements following US GAAP and SEC guidelines.
• Ensure the timely completion of quarterly and year-end closing processes, meeting all financial reporting deadlines.
• Assist with internal and external auditor requests.
• Collaborate with various internal departments to collect, analyze, and report information necessary for internal and external financial reports.
• Prepare schedules and perform analytics required for reporting and management review, including critical footnotes involving ASC 842 leases, ASC 310 receivables and credit risk, ASC 850 related party transactions, and accounts payable and accrued expenses.
• Maintain and organize financial databases to ensure accuracy and accessibility of financial information.
• Uphold compliance with Sarbanes-Oxley Act (SOX) regulations.
• Assist management with ad-hoc procedures and special projects as needed.
• Assist in the consolidation process by ensuring accurate elimination of intercompany balances.
• Prepare monthly journal entries and ensure we maintain complete records of these transactions.

Senior Financial Reporting Analyst

Director

• Lead the development and execution of network strategy for the SD and OC markets, ensuring alignment with Astrana Health’s business goals and growth priorities
• Identify market expansion opportunities, evaluate competitive landscape, and recommend strategies for provider exclusivity, acquisition, retention, and optimization
• Serve as the primary executive representative for all regional provider network operations
• Build and maintain strong, collaborative relationships with physicians, medical groups, ambulatory clinics, health systems, hospitals, and other network partners
• Oversee onboarding, integration, and ongoing support for contracted providers to ensure positive engagement and satisfaction
• Lead provider performance discussions, including quality metrics, utilization trends, and financial performance
• Direct contracting strategic efforts, in coordination with Provider Contracting, across SD and OC, including negotiating rates, value-based arrangements, capitation agreements, and strategic partnerships
• Contribute to Payor Contracting initiatives and negotiations with market information and Network Management insights and data
• Ensure compliance with regulatory requirements, health plan standards, and contractual obligations
• Partner with MSO leadership, claims, UM, CM, Risk/Quality, analytics, and finance teams to drive operational excellence across assigned markets
• Analyze network performance, identify gaps, and implement corrective action plans to improve quality, utilization, access, and financial outcomes
• Impact profitability and market position by managing the following: strategic membership growth initiatives, medical loss ratio, performance program compliance (HEDIS, P4V, STARS), clinical care program participation, encounter data submissions, provider satisfaction, provider contract strategy and physician rewards
• Oversee dashboards, KPIs, and reports to provide clear visibility into network health
• Lead and mentor regional network teams, supporting network managers, provider relations, contracting, and operational alignment
• Collaborate closely with senior leadership, market presidents, and clinical executives to ensure a unified strategy across Southern California markets
• Represent Astrana Health in market-level committees, health plan meetings, and industry events as needed

Senior Director/VP – Market Leader

• Use data engineering best practices to produce high quality, maximally available data models which are intuitive to data analysts and trusted by stakeholders
• Develop deep domain knowledge in healthcare operations, tracking regulatory developments related to analytics products you maintain
• Apply quality measures and other metrics to datasets originating from internal and external clients
• Build scalable ELT pipelines and business intelligence dashboards as needed, embracing automation wherever possible
• Implement data quality checks which proactively identify data issues and distributional shifts to ensure accuracy of downstream analytical products

Data Engineer – Multiple Levels

Accountant

• Oversees deposits of cash on time while keeping accurate accounting records
• Keeps the manager up to date on all relevant and appropriate matters as it pertains to his/her position
• Prepares monthly journal entries and maintains complete records of these transactions
• Reconciles bank statements and keeps an accurate running total of cash on hand
• Ensures monthly balance sheet account reconciliations are prepared timely and accurately
• Compile and analyze financial information to prepare financial statements including monthly and quarterly management reports in accordance to U.S. GAAP
• Oversees accurate and appropriate recording and analysis of revenues and expenses and ensure financial records are maintained in compliance with accepted policies and procedures
• Ensures accurate and timely monthly, quarterly and year-end close processes making certain all financial reporting deadlines are met
• Assists in preparation and submission of quarterly and annual reports as required by Department of Managed Health Care’s agreement
• Submits quarterly and annual financial reports to the health plans
• Supports the budget and forecast activities; including fluxes preparation against actual results
• Prepares for financial audit and coordinate the audit process including working with external auditors and health plans
• Ensures compliance with relevant laws and regulations and integrity of financial data
• Assists with ad-hoc procedures and tasks as requested from management

Senior Accountant, Healthcare

Community Manager

• Build and sustain strong relationships with community-based organizations to promote membership growth and retention.
• Lead community engagement initiatives that enhance the organization’s visibility and trust within diverse communities.
• Plan, organize, and execute community events, including:
• Senior expos and health fairs
• Doc Talks/Lunch & Learns
• Sponsorships
• Astrana hosted events (fun social events)
• SWAG Center Activities
• Track lead generation from grassroots activities and ensure timely follow-up to convert leads into members.
• Maintain monthly event invite email blast through Campaign Monitor or another platform.
• Collaborate with team to develop and implement outreach and marketing strategies tailored to senior population.

Community Engagement Specialist

Manager

• Provider Performance Monitoring & Engagement
• Monitor overall provider performance utilizing performance reports including quality, utilization, referral management, and risk, as well as provider engagement activities and team feedback.
• Use data insights to prioritize provider engagements and determine the most effective intervention strategies based on performance outcomes and business impact.
• Develop provider profiles and insights to identify key areas in workflows that can be improved, including AWV processes, EMR template design, and scheduling practices. Risk Adjustment & HCC Improvement
• Understand, develop, and implement HCC (Hierarchical Condition Category) improvement activities to support accurate risk adjustment and financial performance.
• Implement provider change management activities, including organizing and structuring provider education sessions and developing tools to enhance clinical documentation and coding accuracy.
• Align in-office activities to support HCC capture and ensure optimal risk adjustment performance across the provider network.
• Quality Improvement & Program Development
• Understand, develop, and implement quality improvement activities such as colorectal screening programs, education webinars, EMR improvement initiatives, and medication management programs (e.g., pill delivery programs).
• Align quality improvement efforts through market vendors and internal stakeholders to ensure coordinated execution across the network.
• Lead provider education and engagement strategies designed to improve HEDIS, Stars, and other quality performance metrics.
• Data Analysis & Performance Reporting
• Analyze claims data, performance reports, and utilization reports using Excel and available technology platforms to identify trends and performance opportunities.
• Translate complex data insights into actionable performance improvement strategies tailored to individual markets and provider needs.
• Monitor progress against established goals and adjust strategies as needed to ensure performance targets are achieved.
• Network Development, Provider Relations & Market Growth
• Use data to identify and establish relationships with key specialty groups to improve patient care and lower cost.
• Establish Joint Operating Committees (JOCs) with network partners to identify opportunities for improvement through data analysis and referral management with PCPs.
• Serve as a key liaison between provider practices and organizational leadership to escalate risks, share insights, and drive strategic alignment.
• Lead network and provider growth initiatives aligned with market expansion priorities, identifying and onboarding new provider partners to strengthen Astrana’s value-based care network.
• Collaborate with Market Operations and network development teams to assess geographic gaps, evaluate provider opportunities, and execute strategies that expand market presence and increase attributed patient populations.
• Support the integration of newly onboarded providers into performance improvement programs, ensuring alignment with quality, utilization, and financial goals from the point of engagement.
• Goal Setting & Cross-Functional Leadership
• Develop long-term and short-term goals with tracking metrics; establish role-based goals that align with Astrana organizational objectives.
• Work with team members to identify key activities that directly impact entity goals, and collaborate with ACO management to set specific performance targets for quality or financial improvement.
• Partner with internal stakeholders across Market Operations, Quality, and Population Health to ensure alignment on performance improvement initiatives.
• Manage multiple large, cross-functional projects simultaneously, ensuring timely delivery and measurable impact.

Manager – Market Performance & Improvement

Accounting Manager

• Drive process improvement and overall accounting team efficiencies
• Responsible for all aspects of accounting including accounts receivable, revenue and expense accruals, bank/account reconciliations, etc
• Ensures monthly, quarterly, and year-end close are completed timely and accurately for regulation requirements
• Oversees accurate and appropriate recording journal entries and ensure financial records are maintained in compliance with accepted policies and procedures
• Reviews monthly financial statements and fluxes
• Keeps Controller and executives up to date on all relevant and appropriate matters as it pertains to their position
• Monitors and supports taxation requirements for provision, as well as Form 1099 filings
• Collects / analyzes financial information and develops and maintains financial databases
• Ensures compliance with relevant laws and regulations and integrity of financial data
• Assists with ad-hoc procedures and tasks as requested from upper management

Medical Director – Utilization Management

Inpatient Medical Director – SoCal

Senior Counsel, Managed Care Operations

Risk Adjustment Coding Specialist II

Medical Director – Utilization Management

Manager – Data Engineering

Senior Financial Reporting Analyst

Senior Director/VP – Market Leader

Data Engineer – Multiple Levels

Senior Accountant, Healthcare

Community Engagement Specialist

Manager – Market Performance & Improvement

Accounting Supervisor

Senior Accountant

Senior Accountant