Jobs at Astrana Health, Inc.

Leads specialist capitation provider contracting strategies, negotiations, relationships, reimbursement modeling, contract administration, and compliance. Oversees DOFRs, amendments, RFPs, contracting initiatives, risk assessment, and issue resolution while partnering with Claims, Configuration, Business Development, and Data Management. Provides executive guidance, reports, and recommendations regarding network adequacy, financial impact, regulatory requirements, and strategic opportunities. Establishes enterprise contracting processes and serves as the escalation point for critical provider and payer issues.

Provides patient-centered med-surg nursing care under experienced preceptor guidance. Assesses patients, develops and implements individualized care plans, evaluates treatment responses, coordinates discharge planning and referrals, advocates for patients, and collaborates with physicians and interdisciplinary teams. Supports patient safety, quality initiatives, effective communication, and evidence-based practice while addressing patients’ physical, psychosocial, emotional, and developmental needs.

Conduct high-volume retrospective and prospective chart reviews to identify risk-adjustment coding gaps and verify ICD-10-CM documentation compliance. Audit medical records, analyze HCC and provider performance metrics, educate physicians and practice staff, and provide feedback on documentation and coding issues. Maintain knowledge of coding regulations, mentor staff, support process improvements, and assist with projects. The role requires travel to Houston-area provider offices up to 75% of the time while being remotely based in the U.S.

Lead 24/7 perioperative services, overseeing clinical care, staffing, quality, patient safety, regulatory compliance, financial performance, and operational efficiency. Develop and mentor nursing leaders and staff, manage recruitment and performance processes, maintain staffing and payroll, and collaborate with surgeons, anesthesiologists, physicians, and hospital departments. Drive evidence-based care, quality improvement, patient satisfaction, employee engagement, and continuous performance improvement across surgical services.

Design, develop, and maintain data systems, ETLs, reports, and dashboards to meet delegated and regulatory reporting for Claims and Provider Dispute Resolution. Extract, validate, and analyze data, perform root cause analysis, support dataset architecture, and present findings to stakeholders while ensuring compliance, performance measurement, and change management.

Provide analytics, reporting, operational, and project support for Texas provider networks and delegated arrangements. Build dashboards, analyze provider and market data, support delegation readiness, track ACO/provider participation, coordinate cross-functional projects, prepare executive materials, and monitor timelines and action items to improve provider satisfaction and market performance.

Coordinates specialty care referrals and prior authorizations through insurance portals, sends referrals to specialists, follows up with patients and providers, requests consult notes, communicates coverage requirements, responds to patient inquiries, tracks referral status, and maintains accurate patient documentation. Processes authorizations for medications, injections, and biologics while providing courteous customer service and handling incoming calls.

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.

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.

Build and own actuarial models for forecasting, reserving, shared savings, provider performance, and ACO optimization. Lead actuarial diligence for ACO acquisitions and business development, own financial tracking and reporting for ACO programs, analyze CMS rules, support SOX-compliant audit documentation, and collaborate with Finance, Data, Analytics, Contracting, Medical Economics, and Operations teams.

Supports provider network administration by coordinating onboarding, demographic updates, credentialing and contracting workflows, roster maintenance, provider data accuracy, documentation, reporting, audits, and cross-functional operational activities. The role requires regular local travel throughout the San Jose and Santa Clara County market and involves collaboration with provider offices and internal healthcare operations teams.

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.

Plan, design, and deliver nursing education and orientation programs; assess and maintain clinical competencies; coach staff; support quality, safety, and professional development across nursing teams.

Owns tracking, modeling, forecasting, and executive reporting for health plan incentive revenue across Medicare Advantage, Medicaid, Commercial, Exchange, and ACO programs. Monitors quality measures and payout thresholds, identifies revenue opportunities and risks, reconciles internal and plan-reported results, and supports contract negotiations. The role also builds repeatable data pipelines, quality controls, dashboards, and recommendations while partnering with clinical, operational, data engineering, and executive stakeholders.

Authors and governs risk adjustment coding policies, documentation standards, audit-defense positions, compliance guardrails, coder quality rubrics, and regulatory change controls. Translates model and payer requirements into enforceable rules, resolves ambiguous coding cases, leads coder and CDI training, and builds SQL reporting to measure opportunity, accuracy, policy impact, and inter-rater reliability. Partners with Compliance, Data Science, Finance, CDI, and provider network teams while monitoring compliance and revenue risks.

Schedules radiology procedures and exams, provides patient preparation instructions, confirms provider orders and insurance authorizations, verifies coverage, manages referrals and faxes, coordinates records and authorization requests, and supports front desk operations. The role requires Mandarin or Cantonese fluency, strong communication, organization, multitasking, and patient-service skills in an in-person medical office setting.

Reviews medical records and provider documentation to identify risk adjustment coding gaps, validate ICD-10-CM and HCC coding, conduct audits, and ensure CMS compliance. Educates physicians and practice staff, analyzes performance metrics, reports noncompliance, recommends process improvements, and supports coder training. The hybrid role requires frequent travel to provider offices in Orange County.

Prepare and reconcile financial statements and journal entries in accordance with U.S. GAAP, manage month/quarter/year-end close, coordinate audits and reporting to health plans, analyze revenues and expenses, maintain internal controls, and support ad-hoc financial tasks and regulatory submissions.

Responsible for building data models, developing ELT pipelines, implementing data quality checks, and utilizing best practices in data engineering and healthcare analytics.