Job Title: Director, Utilization Management. Department: Health Services - UM. About the Role. . . Leads and shapes the Utilization Management (UM) Strategy for Astrana Health while providing management oversight in implementing, directing, and monitoring the Utilization Management Department functions, including prior authorizations, concurrent review, medical claims review, and appeals and grievances. Directs the Utilization Management Departme...
Job Title: Claims Examiner III. Department: Operations – Claims. . About the Role. . We are currently seeking a highly motivated Claims Examiner. This role will report to the Manager - Claims and enable us to continue to scale in the healthcare industry. . What You'll Do. . Performs through review of pended claims for billing errors and/or questionable billing practices that might include duplicate billing and unbundling of services. Processes no...
About the Role. . We are currently seeking a highly motivated, full-time Medical Assistant to assist our primary care clinic and enable us to continue to scale in the healthcare industry. This role will report to the Office Manager. . . What You’ll Do. . Assists physicians, nurses, and other medical staff by performing administrative and clinical duties under the direction of a physician. . Administrative duties may include scheduling appointment...
Title. Accounting Manager. Department. Finance - Accounting. About The Role. . As the Accounting Manager, you will be responsible for managing day-to-day accounting operations of the company, reporting to the Controller. You will ensure accurate financial reporting, compliance with accounting standards, and conduct insightful financial analysis. Working closely with the Controller and cross-functional teams, you will contribute to the financial p...
Job Title: Manager - Audit. Department: Finance - Accounting. . About the Role. . As a member of Astrana Health’s Internal Audit department, the Audit Manager is responsible for all aspects of the SOX 404 compliance process including assisting with annual planning, performing walkthroughs, and performing controls testing to evaluate the design and operating effectiveness of key internal controls over financial reporting (ICFR). Under the directio...
Job Title: Sr. Manager - IT Audit. Department: Finance - Accounting. . About the Role. As a member of Astrana Health’s Internal Audit department, the IT Audit Manager is responsible for planning and performing operational and compliance audits of information systems and applications of the company, its subsidiaries, and its external IT service providers. Under the direction of the Director of SOX, the IT Audit Manager leverages their understandin...
Job Title. Cardiovascular and Thoracic Surgeon in San Gabriel Valley, CA. This is a California position located in the San Gabriel Valley, extending into the regions of Anaheim and Pomona. About the Role. Southern California Heart Centers is a high-volume regional leader in Cardiovascular Surgery seeking to add one to two full-time additional surgeons to their prestigious team and thriving practice. Required Qualifications. Board Certified in Tho...
Job Title: Case Manager, RN. Department: Health Services - ICM. About the Role. Astrana Health is looking for a RN Case Manager and we are willing to train a RN without case management experience. . What You'll Do. Comply with Case Management Department’s policies and procedures. 95 - 100% compliance with Utilization Management health plan delegation standards for Case Management. Utilize Milliman Care Guidelines criteria for appropriateness of t...
Job Title: Quality and Access Nurse Practitioner - Contract. Department: AMG. About the Role: . We are seeking a skilled, compassionate, dynamic Primary Care Nurse Practitioner to propel us forward as we improve quality and access for the 300,000 members of the community we serve. You will play a vital role in providing exceptional medical care across the community, expanding your impact beyond that of a single medical practice or telehealth-firs...
Job Title. . . Provide. r. . Relations. . Manager. Department. . Provider Relations. . Department. . . . About the Role. . We are currently seeking a highly motivated. . Provider Relations Manager responsible for field and office activities in providing education and supporting the IPA’s. . providers. . network. The Provider Relations Manager will be working with contracted providers on managed care operations and to comply with IPA and Health Pl...
Job Title: Case Manager (LVN) - HYBRID. Department: Health Services - ECM. About the Role. Provide efficient and effective Care Management to qualified members by addressing the member’s medical, physical and psychosocial needs. Using clinical judgement develops, modifies and assists the member to implement their care plan. Ensure all tasks are timely and in compliance with time requirements per Model of Care/Health Plan/DHCS. This position will ...
Job Title: Utilization Management Coordinator. Department: Health Services - UM. . About the Role. The Utilization Management Coordinator is responsible for supporting clinical, management, and client activities, comprising the UM Program. The Utilization Management Coordinator understands all UM processes such as pre-authorizations, retro reviews, Division of Financial Responsibilities and Health Plan contracts. The UM Coordinator will ensure w...
