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

Requirements

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

Benefits

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

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

clinical strategycomplex case managementutilization managementmedical necessity reviewcost containment initiativesevidence-based practicepopulation healthSQLbusiness intelligenceKPI development

Soft Skills

strong judgmentclear communicationcollaborationadaptabilitycredibilityhumilitycuriosityaccountabilityproblem-solvingbuilder's mindset

Certifications

NP licenseRN licensePA licenseMD licenseDO licenseMaster’s in Healthcare Administration