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Director, Care Management

1 week, 1 day ago
United States
Full-time
Lead
Operations Manager
Project and Program Management
Mode SQL Tableau
Apply Now
Sana Benefits

Sana Benefits

Sana Benefits offers dependable and affordable health insurance solutions for small businesses, including medical, dental, and vision coverage, as well as $0 healthcare options like virtual care and maternity services.

Insurance
251-1K
Founded 2017
$107M raised
View All Jobs 4

Description

  • Champion the payer-side clinical strategy for coverage policies, utilization decisions, and pharmacy guidelines.
  • Lead a small clinician-led team responsible for complex case management, utilization management, and high-cost claimant review.
  • Drive cost containment initiatives through clinical partnerships, tooling, and benefit design.
  • Develop and evolve evidence-based coverage guidelines, benefit design, and formulary policy.
  • Partner with the PBM and Operations team to improve pharmacy programs while protecting adherence and reducing member friction.
  • Work with Underwriting to assess clinical risk for quoting and renewing employer groups.
  • Collaborate with Analytics on medical economics, population health initiatives, and employer-group insights.
  • Partner with Network Operations, Care Navigation, and virtual care teams to inform future contracting priorities based on care gaps.
  • Serve as the clinical voice in designing internal payer tools, coverage engines, UM workflows, and cost-transparency experiences.
  • Build reporting structures and evolve KPIs to measure clinical efficacy and member outcomes.

Requirements

  • Valid license to practice as an NP, RN, PA, MD, or DO, or a Master’s in Healthcare Administration.
  • 8+ years of experience spanning hands-on clinical care and payer-side population health work, including case management and/or utilization management.
  • Prior startup or early-stage experience is a plus.
  • Ability to make difficult tradeoffs between cost, access, and clinical outcomes.
  • Credibility with both clinicians and operators, with the ability to translate 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 such as Tableau or Mode is a plus.
  • Builder’s mindset with comfort improving existing tools and creating new processes and frameworks from scratch.
  • Ability to operate in a fast-moving startup environment where priorities change and roles are not rigidly defined.
  • Clear, thoughtful communication and a collaborative working style.
  • Deep alignment with Sana’s mission and a strong motivation to improve healthcare for people and employers.

Benefits

  • Full sponsorship for state licensure renewals and continuing education units (CEUs).
  • Remote-first work with a fully distributed team and no return-to-office mandate.
  • Flexible vacation policy.
  • Medical, dental, and vision insurance with 100% company-paid employee coverage.
  • 401(k) with company match, plus FSA and HSA plans.
  • Paid parental leave.
  • Short- and long-term disability coverage, plus life insurance.
  • Competitive stock options, transparent compensation, formal career development programs, a one-month sabbatical after 5 years, home office stipends, and an ongoing learning budget.

Interested in this position?

Apply directly on the company website

Apply Now

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