The Role
Leads and builds the organization’s pharmacy function on the health plan side, owning specialty and provider-administered drug utilization management, prior authorizations, appeals, clinical criteria, and cost-of-care initiatives. Develops specialty pharmacy contracting, clinical pathways, formulary and UM criteria, reporting dashboards, compliance processes, and team infrastructure. Partners with medical, care management, network, finance, and compliance teams while personally handling complex case reviews.
Summary Generated by Built In
Astrana Health is a physician-centric, technology-enabled healthcare company built to deliver accessible, high-quality, high-value care. As our value-based membership has grown, so has the complexity and cost of specialty and drug-related utilization. This is a newly created, high-visibility role: Astrana's first dedicated pharmacy leader on the health plan/payer side, responsible for standing up a formal pharmacy function to manage drug utilization management (UM) and lead cost-of-care strategy across our specialty and provider-administered drug spend.
This is a working director role. You will set pharmacy strategy and build the function, while also rolling up your sleeves on complex utilization management reviews and cost initiatives in the near term. It's an opportunity to build a pharmacy program from the ground up inside a fast-growing, physician-led organization and to directly influence patient outcomes and cost of care at scale.
What You'll Do
- Lead and build out Astrana's pharmacy function, serving as the organization's first dedicated pharmacy leader for drug-related utilization management and clinical pharmacy strategy.
- Own end-to-end utilization management for provider-administered (J-code) and specialty drugs, including prior authorization review, clinical criteria, and appeals, while personally handling complex case reviews as a working director.
- Design and lead cost-of-care initiatives across biosimilar conversion, site-of-care optimization, dose optimization, white labeling, and Buy-and-Bill-to-Part D (B to D) conversion.
- Develop and manage specialty pharmacy contracting strategy, and direct appropriate volume to Astrana's own specialty pharmacy channel where clinically and financially appropriate.
- Partner with medical directors, care management, and network teams to build clinical pathways and formulary/UM criteria for high-cost specialty and infusion therapies.
- Build and maintain reporting and dashboards that track drug spend trends, savings initiatives, and UM turnaround-time performance for leadership.
- Collaborate cross-functionally with Health Services, Network Management, Finance, and Compliance to align pharmacy strategy with broader organizational goals.
- Monitor the regulatory and payer landscape (CMS, state Medicaid, health plan formularies) affecting specialty drug and UM requirements, and ensure programs remain compliant.
- Establish policies, workflows, and documentation standards for the pharmacy function, and help scope and build out the team as volume and scope grow.
Qualifications
- Doctor of Pharmacy (PharmD) required, with an active, unrestricted pharmacist license (California license required or willingness to obtain promptly).
- 5+ years of experience in managed care pharmacy, PBM, or health plan utilization management, including direct experience managing J-code/provider-administered specialty drug review.
- Demonstrated track record leading cost-of-care pharmacy initiatives such as biosimilar conversion, site-of-care optimization, or specialty pharmacy contracting.
- Hands-on experience with utilization management workflows, prior authorization criteria design, and P&T (Pharmacy & Therapeutics)-type governance processes.
- Strong analytical skills, with the ability to build and track savings and ROI models for pharmacy programs.
- Comfortable operating as a working leader, balancing strategic program-building with hands-on case review and day-to-day execution.
- Excellent cross-functional communication skills and experience partnering with medical directors, network, finance, and compliance teams.
- Experience in a value-based care organization, IPA, MSO, or health plan strongly preferred.
- Board certification (e.g., BCPS, BCACP) a plus.
Environmental Job Requirements and Working Conditions
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754.
- The national target pay range for this role is $175,000 - $225,000 total compensation including base, bonus, and equity (RSUs). Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
About
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.
Skills Required
- Doctor of Pharmacy (PharmD)
- Active, unrestricted pharmacist license
- California pharmacist license or willingness to obtain promptly
- 5+ years of experience in managed care pharmacy, PBM, or health plan utilization management
- Direct experience managing J-code or provider-administered specialty drug reviews
- Track record leading pharmacy cost-of-care initiatives, such as biosimilar conversion, site-of-care optimization, or specialty pharmacy contracting
- Hands-on experience with utilization management workflows, prior authorization criteria design, and Pharmacy and Therapeutics governance processes
- Strong analytical skills, including building and tracking pharmacy savings and ROI models
- Ability to balance strategic program-building with hands-on case review and daily execution
- Excellent cross-functional communication skills and experience partnering with medical directors, network, finance, and compliance teams
- Experience in a value-based care organization, IPA, MSO, or health plan
- Board certification, such as BCPS or BCACP
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The Company
What We Do
Astrana Health is a physician-centric, technology-powered healthcare company that operates an integrated delivery platform. It enables providers to participate in value-based care arrangements, helping them deliver accessible, high-quality, and cost-effective care to patients. The company provides care coordination services to patients, primary care physicians, specialists, and health plans, leveraging proprietary technology to streamline operations and improve patient outcomes across local communities.
