Title: Medical Director - Utilization Management Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Fully remote Compensation: $275,000 - $325,000 / year Full-time Department: HS - UM Job Description: 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. Our Values: - Put Patients First - Empower Entrepreneurial Provider and Care Teams - Operate with Integrity & Excellence - Be Innovative - Work As One Team What You'll Do Prior Authorization Management - Review and issue timely determinations for prior authorization requests, ensuring medical necessity, regulatory compliance, and alignment with evidence-based clinical guidelines. - Collaborate with care management and operational teams to streamline and enhance prior authorization workflows for efficiency and provider satisfaction. - Provide clinical leadership in the development, implementation, and regular updating of authorization criteria and policies based on the latest medical standards. - Promote transparency by clearly documenting and communicating authorization decisions to providers and members, including rationale and guidance for alternative treatment options when applicable. Utilization Management - Provide oversight for the daily activities of the UM program, ensuring services are delivered appropriately and in accordance with clinical best practices. - Analyze utilization data to identify trends, high-cost drivers, and opportunities for care optimization and cost containment. - Participate in the clinical review of complex or high-cost cases, offering recommendations rooted in medical necessity and member-centered care. - Collaborate with interdisciplinary clinical teams to ensure the appropriate use of healthcare resources without compromising quality. Quality Assurance and Improvement - Ensure all UM activities meet applicable federal, state, and accreditation standards (e.g., CMS, NCQA). - Lead and contribute to quality improvement initiatives focused on enhancing the effectiveness, accuracy, and consistency of the prior authorization and UM processes. - Conduct audits and peer reviews to validate adherence to guidelines and evaluate the quality of medical decision-making. Provider and Member Communication - Serve as the primary clinical contact for complex medical necessity determinations and escalated provider appeals. - Build strong working relationships with providers by offering education and clarity around the prior authorization process and criteria. - Support member care continuity by suggesting medically appropriate alternatives when requested services are denied. Regulatory Compliance and Accreditation - Ensure full compliance with all applicable UM regulatory and accreditation standards, including NCQA and CMS requirements. - Maintain up-to-date knowledge of evolving healthcare laws, policies, and industry standards affecting prior authorization and UM processes. - Lead internal efforts to prepare for and maintain UM-related accreditation, including audits, documentation, and process improvement. Data Analysis and Reporting - Monitor and analyze prior authorization and UM metrics (e.g., denial rates, turnaround times, appeal volumes) to identify performance gaps and track progress. - Use data-driven insights to inform strategic decisions, improve process efficiency, and support cost management goals. - Provide regular updates and reporting to senior leadership on program performance, cost impact, compliance status, and quality indicators. Qualifications - 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. Environmental Job Requirements and Working Conditions - This position is fully remote, with some travel to SoCal required as needed. Candidates must have a CA medical license. - 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. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change. About Astrana Health, Inc. Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

Role Description Do you crave an intellectually stimulating role that lets you apply your clinical expertise while continuing to grow and make an impact? As a Medical Director at EviCore, part of Evernorth Health Services, a division of The Cigna Group, you’ll leverage your background in Otolaryngology to deliver evidence-based medical reviews that support high-quality patient care. Collaborate with healthcare providers and stay current on healthcare regulations and industry developments as you review a wide range of cases. This role offers you the opportunity to build new skills while enhancing the health and vitality of others. We're seeking a detail-oriented individual with good communication, technology, and typing skills, as well as strong clinical judgment. Drive growth in your career with our innovative team. How you’ll make a difference: - You’ll start training remotely in a structured environment with support from trainers, mentors, and leadership to set you up for success. - Complete time-sensitive, specialized evidence-based medical case reviews for medical necessity on EviCore’s case management software. - Conduct physician consultation (peer-to-peer) calls with referring providers to discuss evidence–based medical necessity and appropriateness of the requested service or treatment. - Leverage your clinical expertise to recommend alternative services or treatments as necessary. - Work collaboratively with over 500 EviCore physician colleagues to help ensure patients receive proper care via evidence-based decision making. Qualifications - M.D. or D.O. with a current, active U.S. medical license and board certification (ABMS or AOA) in Otolaryngology. - Eligible to acquire additional state licensure as required. - 3 or more years of relevant clinical experience post residency/fellowship. - Knowledge of applicable state and federal laws, Utilization Review Accreditation Commission and National Committee for Quality Assurance standards is a plus. - Ability to commit to a set, weekly work schedule (Monday through Friday). - Strong computer skills: ability to work autonomously with automated processes, computer applications, and systems. - Meet physical demands of the role including, but not limited to, typing, speaking, and listening 100% of time. - In accordance with our HITECH Security Accreditation, company provided encrypted-workstation is required to be hard-wire connected to a modem or router. Wireless connection is not permitted. - If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. Requirements - For this position, we anticipate offering an annual salary of 207,800 - 346,300 USD / yearly, depending on relevant factors, including experience and geographic location. - This role is also anticipated to be eligible to participate in an annual bonus plan. Benefits - Benefits start on day one. - Predictable work schedules. - 100% work from home. - 8 Paid Holidays + 23 PTO Days. - 401(K) with company match. - Reimbursement for continuing medical education. - Career growth opportunities across the enterprise. - Networking with peers across multiple medical specialties.

Role Description The Associate Director of Medical Affairs will provide strategic and scientific expertise to support the company’s portfolio and pipeline, while playing a key role in executing Medical Affairs strategy and tactics. This individual will act as the VP of Medical Affairs' deputy and serve as a subject-matter expert for assigned products, while maintaining expertise across the company’s entire portfolio. They will be responsible for developing and executing medical plans, maintaining day-to-day Medical Affairs operational excellence, supporting evidence generation, and ensuring the alignment of medical strategies with clinical and corporate objectives. The role requires a balance of scientific knowledge, organization, strategic thinking, and the ability to build strong relationships both internally and externally. Core Responsibilities - Medical Strategy and Operations: - Work with medical leadership to develop and execute medical strategies to support Harrow’s product portfolio/disease areas of interest, maintaining alignment with corporate objectives. - Develop and maintain therapeutic area expertise across the Harrow ophthalmic portfolio sufficient to support any product on a cross-cover basis. - Contribute medical and competitive insight into brand and lifecycle planning. - Coordinate cross-functional medical projects and deliverables, managing competing priorities across a broad portfolio. - Support and help maintain departmental processes, standards, and documentation. - Evidence Generation & Data Dissemination: - Develop high-quality analysis of Investigator Initiated Study grant requests to ensure alignment with strategies, acceptable risk/benefit ratios, impact on current and future scientific landscape, and fair market budget assessments. - Partner with Medical Communications and relevant internal and external colleagues to oversee dissemination of scientific data through publications, congress presentations, advisory boards, and symposia. - Support evidence-generation and key-brand scientific initiatives, helping move strategic projects from concept to execution. - Stakeholder Engagement: - Serve as a reviewer in Medical/Regulatory/Legal committees for all assigned materials to ensure scientific accuracy, alignment with strategic messaging, and that materials are fair and balanced. - Build and maintain strong relationships with KOLs, investigators, medical societies, centers of excellence, and other external experts in partnership with Field Medical. - Represent the company at scientific congresses, advisory boards, and medical education events in partnership with Field Medical. - Provide scientific and medical expertise to internal and external stakeholders, ensuring timely and accurate information exchange. - Maintain compliance with all legal, regulatory, and ethical standards. Qualifications - Terminal Degree MD/DO/OD/PhD/PharmD preferred. - Extensive ophthalmic experience required. - A minimum of 3 years of pharmaceutical industry experience in an internal strategic Medical Affairs or internal Marketing role required. - Extensive experience working on promotional and internal review teams (PRC/MRL) required. - Experience working with broad product portfolios is highly preferred. - Experience in scientific presentations and medical writing is preferred. - Broad knowledge of product development, regulatory requirements, payer landscape, and life cycle management preferred. - Proven ability and experience to develop and foster peer-to-peer, credible relationships with Medical Experts/decision makers. - Working knowledge of the Healthcare System and of the research procedures as well as the ICH guidelines, GCP, and other ethical guidelines. - Strong analytical skills, ability to interpret scientific/clinical literature. - Proficient with MS Office applications. - Fluency in reading, writing, understanding, and communicating in English is required. Requirements - Position Type: Remote – Must live in United States. - Travel: Up to 30%. - Some activities may call for early or late meetings and attendance at scientific meetings on holidays and weekends.

Role Description The Director, Field Medical Affairs is a national leadership role responsible for defining and executing the Field Medical strategy for the community segment, aligned to US Medical Affairs and enterprise priorities. This role leads a team of Medical Science Liaisons (MSLs) and is accountable for translating strategy into disciplined execution, measurable outcomes, and sustained scientific impact. This leader demonstrates strong executive presence and leadership credibility, serving as a trusted voice of Field Medical in cross-functional and Medical Affairs leadership forums. The Director ensures medical and scientific priorities are effectively and compliantly integrated into regional and national plans, while influencing senior stakeholders and shaping enterprise decisions. Success in this role requires a balance of strategic thinking and execution rigor, along with the ability to lead through influence, drive alignment across stakeholders, and elevate field medical impact at scale. The Director also plays a critical role in driving performance through KPIs, strengthening coaching and capability development, and building a high-performing national MSL organization. Key Responsibilities - Lead and develop a national team of MSLs, fostering a high-performance culture grounded in accountability, continuous development, and strong scientific engagement. - Define and execute the Field Medical strategy for the community segment, ensuring alignment to US Medical Affairs priorities and enterprise objectives. - Translate strategy into clear field medical plans, execution frameworks, and measurable outcomes across regions. - Establish and drive KPIs and performance metrics to assess field impact, ensure execution quality, and enable data-driven decision-making. - Ensure consistent, high-quality, and compliant execution of field medical activities across the organization. - Provide ongoing coaching, performance feedback, and leadership development to enhance MSL effectiveness, strategic thinking, and engagement quality. - Represent and lead the Field Medical voice in cross-functional forums, demonstrating executive presence and influencing stakeholders to ensure appropriate and compliant integration of medical priorities into regional and national plans. - Shape cross-functional strategies by incorporating field insights, scientific perspectives, and medical priorities, ensuring alignment with US Medical and enterprise strategy. - Ensure all cross-functional engagement and planning are conducted with strong compliance, scientific integrity, and adherence to Medical Affairs governance standards. - Serve as a strategic liaison across Medical Affairs and cross-functional partners, proactively aligning priorities, removing barriers, and strengthening coordinated execution. - Lead national account planning approaches and field deployment strategies to optimize engagement with key healthcare systems and providers. - Demonstrates resilience, determination, and follow-through in the face of complexity, setbacks, or resistance; maintains focus on strategic priorities; and drives initiatives. - Oversee budget planning and resource allocation, ensuring disciplined investment aligned to strategic priorities. - Represent Field Medical in Medical Affairs leadership discussions, bringing forward field insights and strategic perspectives to influence enterprise decisions. Qualifications - Advanced degree (PharmD, PhD, MD, or DO) - 12+ years of Medical Affairs experience, including field medical leadership - Proven ability to lead and develop high-performing MSL teams at scale - Demonstrated strength in executive presence, influencing senior stakeholders, and operating effectively in leadership forums - Strong track record of strategy development, execution, and cross-functional leadership - Experience with KPI-driven performance management, coaching, and organizational leadership - Experience in cardiology, rare disease, or specialty biopharma preferred - Willingness to travel (~50–60%) Benefits - Comprehensive benefits including medical, dental, and vision coverage - Life and disability insurance - Lifestyle reimbursement program - Flexible spending and health savings accounts - 401(k) with a generous company match - Paid time off, wellness days, holidays, and two company-wide recharge breaks - Generous family resources and leave Company Description We are the leader in RNAi therapeutics – a revolutionary approach with the potential to transform the lives of people with rare and common diseases. Built on Nobel Prize-winning science, Alnylam has delivered the breakthroughs that made RNAi therapeutics possible and are just at the beginning of what’s possible. Our deep pipeline, late-stage programs, and bold vision reflect our core values: fierce innovation, passion for excellence, purposeful urgency, open culture and commitment to people. We're proud to be a globally recognized top employer, where an authentic, inclusive culture and breakthrough thinking fuel one another.