Medical Director - Utilization Management (Part Time)

What You'll Do

• 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.

Qualifications

• MD or DO; Board Certified in Internal Medicine, Family Medicine, or a relevant outpatient specialty required.
• Active, unrestricted medical license (California required).
• 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 PCPs and ambulatory specialists in value‑based care models.
• Strong physician‑to‑physician communication and clinical judgment.

Environmental Job Requirements and Working Conditions

• This is a Remote - US based position.
• The national target base salary range for this role is: $250,000 - $325,000. Actual compensation will be determined based on geographic location (current or future), experience, or other job-related factors.