Director, Care Management

🕒 Abril 24

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $155.000 - $175.000 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

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Sana

SiteLinkedInTodas as Vagas

51 - 200 funcionários

⚕️ Seguro de Saúde

☁️ SaaS

🤝 B2B

💰 $60.000.000 Series B em 2022-06

Healthcare Insurance • SaaS • B2B

A Sana é uma empresa que fornece benefícios de saúde modernos, especialmente desenvolvidos para pequenas empresas. A empresa oferece planos de saúde abrangentes que incluem cobertura médica, odontológica e oftalmológica, além de opções de saúde com custo zero, como atendimento virtual, maternidade, laboratórios e serviços de imagem. A Sana visa simplificar a gestão dos benefícios de saúde, oferecendo recursos como gestão de funcionários em tempo real e visualização transparente de sinistros. Com foco na acessibilidade, as empresas podem economizar até 20% ao escolher a Sana, com uma alta taxa de renovação entre os clientes. Seu serviço inclui uma equipe dedicada de médicos e especialistas em benefícios para auxiliar os membros com orientações e encaminhamentos dentro da rede. A Sana enfatiza um forte suporte ao cliente com altos índices de satisfação, garantindo que os funcionários possam manter seus prestadores preferidos sem incorrer em taxas fora da rede. A empresa se orgulha de ser uma opção confiável e econômica para pequenas empresas.

Descrição

• 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

🎯 Requisitos

• A 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 population health work including case management and/or utilization management; 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

🏖️ Benefícios

• 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) with company match, 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