Jobs at Astrana Health, Inc.

Lead 24/7 clinical, staffing, quality, and financial operations for the Operating Room. Ensure regulatory compliance, patient safety, and satisfaction. Manage hiring, coaching, training, performance, discipline, and payroll; collaborate with other departments to support organizational initiatives.

Manage day-to-day accounting operations, lead and develop accounting staff, ensure month-end/year-end close, maintain GAAP-compliant records, reconcile ledgers, support SEC filings and external audits, and improve financial systems and controls for IPA entities.

Conduct high-volume chart reviews to identify HCC and ICD-10 coding gaps, perform code abstraction and audits, educate providers and practice leaders, track KPIs (HCC recapture, AWVs), mentor staff, and recommend process improvements to support risk adjustment program goals.

Process and manage prior authorization deferrals and denials in compliance with health plan, state, federal, and NCQA standards. Verify eligibility and benefits, complete denial packets, use UM systems and templates, respond to inquiries, maintain accurate records, collaborate with teams, and meet turnaround time and quality requirements while ensuring HIPAA compliance.

Coordinate and process prior authorization and UM referrals (150–250/day), verify eligibility and provider/facility status, attach clinical notes, communicate with providers and internal teams, ensure compliance with UM policies and health plan TATs, and maintain accurate documentation and confidentiality.

Coordinate and review inpatient admissions, determine medical necessity using Milliman Care Guidelines, develop discharge and transition plans, collaborate with hospital staff and providers, perform field visits to partnered hospitals, and report activities to Case Management leadership to reduce readmissions and ensure compliance.

Perform high-volume chart reviews to verify ICD-10/HCC coding accuracy, conduct audits, deliver provider education, track HCC/AWV KPIs, mentor staff, and recommend process improvements to support risk adjustment programs.

Manage and optimize assigned provider network segments to ensure access, panel capacity, and performance. Support provider performance and quality initiatives (HEDIS, STARS), partner with contracting/credentialing and operations, resolve provider escalations, ensure regulatory compliance (DMHC, CMS), support audits and delegated risk requirements, and provide cross-functional market and provider insights to inform network strategy.

Manage provider lifecycle and network operations for the Los Angeles market, supporting onboarding, data accuracy, panel management, issue resolution, network adequacy, quality initiatives (HEDIS, STARS), regulatory compliance, cross-functional collaboration, reporting, and operational readiness to improve provider and member experience.

Assist in the Operating Room by preparing and stocking rooms, maintaining sterile fields, positioning patients, supporting instrument sterilization and equipment checks, ensuring OR safety and proper specimen handling, and providing professional patient-centered communication.

Perform chart reviews and medical record abstraction to identify and close HEDIS care gaps. Apply NCQA HEDIS specifications and coding guidelines, validate and QA clinical data, support audits, collaborate with providers and vendors, analyze results for process improvement, and maintain HIPAA-compliant documentation while meeting productivity and accuracy targets.

Coordinate provider onboarding, updates, and terminations; maintain provider data and directories; monitor workflows to meet SLAs; support cross-functional teams, compliance audits, and operational reporting.

Lead and coordinate PACU unit operations and staff; provide direct and supervisory patient care; manage medications, monitors, ventilators, and invasive lines; develop and document plans of care; coach and orient staff; ensure infection control, HIPAA compliance, and quality standards; collaborate with physicians and interdisciplinary teams to optimize patient outcomes and throughput.

Lead managed care contracting strategy and negotiations, draft and manage payer/provider contracts (risk-based, FFS, ACOs), evaluate reimbursement and financial performance, develop contract analytics/tools, ensure enterprise contracting consistency, resolve payer/provider issues, and manage ad-hoc projects.

Embed with clinical and operations teams to identify high-impact problems and build production AI systems. Design and deploy LLM/RAG-driven tools, data pipelines, APIs, models, and user-facing applications using messy clinical and claims data. Iterate quickly based on real-world feedback and operational needs.

Lead design, development, deployment, and maintenance of scalable web applications and APIs for Astrana's healthcare platform. Collaborate cross-functionally, improve the stack and processes, mentor junior engineers, manage project priorities, and drive technical direction using Python, React, JavaScript, and SQL.

Perform medical record abstraction and chart review to identify and close HEDIS care gaps, ensure data accuracy and NCQA compliance, conduct QA reviews, collaborate with providers and audit vendors, analyze results, and support quality improvement and reporting.

Perform medical record abstraction and chart review to identify and close HEDIS care gaps. Apply NCQA HEDIS specifications, validate and submit clinical data, conduct QA reviews, collaborate with providers and vendors, support audits, analyze results for process improvement, and maintain HIPAA compliance while meeting productivity and accuracy standards.

Provide evidence-based ICU nursing care including assessments, medication administration, developing and evaluating individualized care plans, coordinating interdisciplinary care, supervising/supporting staff, educating patients and families, documenting clinical changes, and advocating for patient needs throughout treatment and discharge.

Provide nursing case management for pediatric and adult patients: assess, plan, coordinate, monitor, and evaluate care transitions; review medical records for medical necessity using Milliman Care Guidelines; collaborate with hospitalists, discharge planners, health plans, and providers; perform onsite hospital case management and maintain utilization management compliance.