Medical Director, Health Plan

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OtherHealthcareMedical Director Health Plan

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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.

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OtherHealthcareMedical Director Health Plan

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 Medical Director, Health Plan to own the clinical strategy of our health plan and ensure the care our members receive is both high quality and cost-effective. This role is the clinical authority on the payer side of the house — accountable for how coverage policies, utilization decisions, case management, pharmacy strategy, cost containment initiatives, and network design translate into real outcomes and sustainable unit economics. Reporting to the VP of Operations, you will be a key partner to Claims, Underwriting and Actuarial, Network Development, Finance, Revenue, and Product & Engineering. While separate from our Care Team, you will work closely with our Chief Medical Officer and virtual primary care team to ensure tight alignment between payer strategy and care delivery.

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.

Own Sana’s clinical strategy as a payer, defining how clinical standards, coverage policies, utilization decisions, and pharmacy strategy translate into high-quality, cost-effective care

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

Partner closely with the operations team and our PBM partner to design evidence-based cost containment programs to bend the pharmacy cost curve without degrading outcomes or adherence, and limiting member friction

Partner with Underwriting to assess clinical risk in quoting and pricing both prospective and renewing employer groups

Set and evolve evidence-based coverage guidelines, benefit design, and formulary policy aligned with high-value outcomes

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 cost containment program reporting structures to measure efficacy and ROI

An MD or DO with board certification

Licensed to practice in Texas or willing to obtain licensure

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 reimbursement 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