Director, Case Management, Health Plan Strategy

Role Overview

• Champion Sana's payer-side clinical strategy, ensuring that coverage policies, utilization decisions, and pharmacy guidelines are rooted in evidence-based practice and translate into seamless, high-quality care for every member
• Build and lead a small clinician-led payer team responsible for in-house complex case management, high-cost claimant review, utilization management, and medical necessity review
• Drive strategy and implementation of cost containment initiatives, including clinical partnership management, tooling, and benefit design
• Set and evolve evidence-based coverage guidelines, benefit design, and formulary policy aligned with high-value outcomes
• Support the Operations team and our PBM partner to drive evidence-based programs to bend the pharmacy cost curve without degrading adherence, and limiting member friction
• Partner with Underwriting to assess clinical risk in quoting and pricing both prospective and renewing employer groups
• Work with Analytics to support medical economics, population health initiatives, and actionable insights for employer groups
• Work with Network Operations, Care Navigation, Sana's virtual care clinic, and Case Management to prioritize future contracting based on real gaps in care for Sana members
• Serve as a primary clinical voice in the design of Sana's internal payer tools, coverage engines, UM workflows, and cost-transparency experiences
• Evolve case management KPIs and build program reporting structures to measure clinical efficacy and member outcomes

Requirements

• An valid license to practice as a NP, RN, PA, MD, DO and/or a Master’s in Healthcare Administration
• 8+ years of experience spanning hands-on clinical care and payer-side, value-based, or population health work; prior startup or early-stage experience is a plus
• Deeply comfortable making hard tradeoffs between cost, access, and clinical outcomes
• Credibility with both clinicians and operators, with the ability to explain clinical nuance to engineers and financial reality to physicians
• Strong judgment under ambiguity and imperfect data; comfort working with analytics, SQL, and business intelligence tools like Tableau or Mode is a plus
• A builder’s mindset, with comfort improving existing tools while designing new processes and frameworks from the ground up
• Comfort operating in a fast-moving, ambiguous startup environment where priorities evolve and roles are not rigidly defined
• Clear and thoughtful communication, whether collaborating asynchronously, writing documentation, or working through complex problems live
• Deep alignment with Sana’s mission and motivation to make healthcare work better for people and employers
• Humility, curiosity, and follow-through, earning trust through strong judgment, accountability, and collaboration

Tech Stack

• SQL
• Tableau

Benefits

• Full sponsorship for state licensure renewals and continuing education units (CEUs) — because keeping your credentials current shouldn't come out of your own pocket
• Remote company with a fully distributed team – no return-to-office mandates
• Flexible vacation policy (and a culture of using it)
• Medical, dental, and vision insurance with 100% company-paid employee coverage
• 401(k), FSA, and HSA plans
• Paid parental leave
• Short and long-term disability, as well as life insurance
• Competitive stock options are offered to all employees
• Transparent compensation & formal career development programs
• Paid one-month sabbatical after 5 years
• Stipends for setting up your home office and an ongoing learning budget
• Direct positive impact on members’ lives – wait until you see the positive feedback members share every day