Jobs at Astrana Health, Inc.

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.

Lead development and maintenance of large-scale distributed systems and software platforms; design, test, deploy, and optimize applications used by physicians and patients; manage EDI analysts; collaborate with cross-functional teams to deliver technical solutions, monitor reliability, and drive system scalability and performance.

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.

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.

Lead and mentor a team of data engineers to design, implement, and maintain scalable data pipelines, ensuring data quality and compliance with healthcare regulations.

The Provider Relations Market Performance Lead analyzes physician practice performance, supports quality improvement, and transforms operations through provider education and collaboration.

The Senior Claims Manager oversees Claims Delegation Audits, ensures compliance with regulations, develops audit strategies, manages corrective actions, collaborates cross-functionally, and leads a performance-driven team.

The Provider Network Strategy Specialist analyzes and develops strategies for provider network growth and engagement, focusing on value-based care goals and contract negotiations.

The Manager of Advanced Analytics will lead the design and implementation of data solutions, mentor team members, and collaborate with stakeholders to drive analytics strategy and improvements in patient outcomes.

Perform prior authorization and retrospective reviews for outpatient procedures, elective admissions, post-homecare services and DME using medical necessity criteria. Refer to Medical Directors as appropriate, maintain regulatory and accreditation knowledge, comply with policies, and support other duties as assigned. Work remotely with rotating weekend/holiday coverage and overtime.

The Senior Accountant prepares financial statements, ensures compliance with U.S. GAAP, manages audits, and oversees budget activities, contributing to financial accuracy and reporting.

The Sr. Internal Auditor oversees SOX compliance, conducts audits, evaluates internal controls, collaborates with stakeholders, and communicates findings to support business objectives.

The role involves providing comprehensive primary care, managing chronic diseases, and collaborating with care teams while focusing on patient-centered care and preventive health.

Provide critical care to ICU patients, assess conditions, administer treatments, lead care teams, and ensure compliance with nursing standards.

Lead FP&A activities including budgeting, forecasting, long-range planning, and financial modeling. Deliver executive reporting and dashboards, analyze revenue, profitability, productivity, and AR metrics. Support business cases, capital planning, and strategic initiatives. Improve reporting processes and data infrastructure, oversee and mentor the FP&A team, and lead ad hoc analyses to support decision-making.

Lead managed care contracting strategy and negotiations, oversee contract administration (DOFRs, amendments, RFPs), ensure compliance and delegation oversight, align contracting with operations, mentor contracting team, provide executive reporting on network adequacy and financial impact.

Lead and stabilize multi-site clinic operations post-acquisition, drive integrations and process improvements, leverage EMR and analytics (SQL, Power BI, Excel) to build dashboards, reduce denials, optimize throughput and revenue, manage cross-functional projects, automate manual processes, and develop clinic managers and frontline teams to meet performance and compliance goals.