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Director, Case Management and Health Plan Strategy

20 hours, 58 minutes ago
United States
Full-time
Lead
Operations Manager
Project and Program Management
Mode SQL Tableau
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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 3

Description

  • Lead the case management function and a small clinician-led payer team covering complex case management, high-cost claimant review, utilization management, and medical necessity review.
  • Champion Sana’s payer-side clinical strategy so coverage policies, utilization decisions, and pharmacy guidelines are evidence-based and support high-quality care.
  • Drive clinical cost containment initiatives through partnership management, tooling, and benefit design.
  • Set and evolve coverage guidelines, benefit design, and formulary policy aligned with high-value outcomes.
  • Work with the Operations team and PBM partner to implement programs that reduce pharmacy costs while protecting adherence and minimizing member friction.
  • Partner with Underwriting to assess clinical risk in quoting and pricing prospective and renewing employer groups.
  • Collaborate with Analytics on 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 care gaps.
  • Serve as a clinical voice in designing internal payer tools, coverage engines, utilization management workflows, and cost-transparency experiences.
  • Evolve case management KPIs and build reporting structures to measure clinical efficacy and member outcomes.

Requirements

  • Active license to practice as an NP, RN, PA, MD, or DO, and/or a Master’s in Healthcare Administration.
  • 8+ years of experience spanning hands-on clinical care and payer-side, value-based care, or population health work.
  • Prior startup or early-stage experience is a plus.
  • Comfort making tradeoffs between cost, access, and clinical outcomes.
  • 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 such as Tableau or Mode is a plus.
  • Builder’s mindset with comfort improving existing tools and designing new processes from the ground up.
  • Comfort operating in a fast-moving startup environment where priorities evolve and roles are not rigidly defined.
  • Clear and thoughtful communication, including asynchronous collaboration and documentation.

Benefits

  • Full sponsorship for state licensure renewals and continuing education units (CEUs).
  • Remote-first, fully distributed team with no return-to-office mandate.
  • Flexible vacation policy.
  • 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 coverage, plus life insurance.
  • Competitive stock options for all employees.
  • Transparent compensation and formal career development programs.
  • Paid one-month sabbatical after 5 years.
  • Home office setup stipend and ongoing learning budget.
  • Base salary of $150,000 - $175,000, with target cash compensation of $155,000 - $175,000 base plus equity for U.S.-based remote locations.

Interested in this position?

Apply directly on the company website

Apply Now

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