Director, Case Management and Health Plan Strategy

RemoteRemoteFull-timeexecutive

OtherDirector Case Management And Health Plan Strategy

0 views0 saves0 applied

Apply Now

Quick Summary

Overview

Sana’s vision is simple yet bold: make healthcare easy. All of us can agree healthcare is simply too hard in the US. And our members feel that pain day in and day out.

Technical Tools

OtherDirector Case Management And Health Plan Strategy

Sana’s vision is simple yet bold: make healthcare easy.

All of us can agree healthcare is simply too hard in the US. And our members feel that pain day in and day out. We aim to create an experience that simply feels easy when you need to access our healthcare system. If you need something, you know where to go to get it with care that is a click (or as few clicks as possible!) away.What’s beautiful about a vision oriented toward “easy” is how it imparts a singular feeling. We instinctively know as humans when something is easy versus hard, even if we can’t explain why. We fight as a company to make an easy pathway available to all our members at every stage of their healthcare journey. If you feel passionate about delivering better healthcare to small businesses through a seamless care experience and affordable benefits, join us!

We're looking for a Director, Case Management and Health Plan Strategy to lead our case management function and the clinical cost containment strategies of our health plan, making sure the care our members receive is high-quality, low friction, and at an appropriate cost. This role is for a clinical leader who understands care from the inside out and wants to shape how a modern health plan works for Sana’s members. You'll bring your patient advocacy lens to the payer side, influencing how coverage policies, utilization decisions, case management, and network design translate into real outcomes for the people we serve.

Reporting to the VP of Operations, you'll be a key cross-functional partner to Claims, Underwriting and Actuarial, Network Development, Finance, Revenue, and Product & Engineering. While distinct from our Sana Care Team, you'll work closely with our Chief Medical Officer and virtual primary care team to make sure payer strategy and care delivery stay tightly aligned. If you care deeply about fixing what’s broken in U.S. healthcare and want real ownership over how a modern health plan actually works, come build with us.

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

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

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