Director, Care Management

Company Vision

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!

Position Overview

We're looking for a Director, Care Management to lead our case management and utilization management functions making sure the care our members receive is high-quality, medically necessary, and at an appropriate cost. This role is for a clinical leader who understands care from the inside out and wants to build innovative solutions to work for Sana Health Plan 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.

What you will do

• 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, utilization management, and high‑cost claimant 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

About you

• License: A valid license to practice as a NP, RN, PA, MD, DO and/or a Master’s in Healthcare Administration
• Experience: 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
• Tradeoffs: Deeply comfortable making hard tradeoffs between cost, access, and clinical outcomes
• Credibility: Credibility with both clinicians and operators, with the ability to explain clinical nuance to engineers and financial reality to physicians
• Judgment: Strong judgment under ambiguity and imperfect data; comfort working with analytics, SQL, and business intelligence tools like Tableau or Mode is a plus
• Mindset: A builder’s mindset, with comfort improving…