Director, Care Management
New
RemoteFull-TimeDirector
Salary$155,000 - $175,000 base + equity per year
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Job Details
- Experience
- 8+ years
- Required Skills
- SQLTableau
Requirements
- Valid 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 population health.
- Demonstrated experience in case management and/or utilization management.
- Deep understanding of the tradeoffs between cost, access, and clinical outcomes.
- Ability to explain clinical nuance to engineers and financial reality to physicians.
- Comfort working with analytics, SQL, and business intelligence tools like Tableau or Mode.
- Builder’s mindset with experience designing new processes from the ground up.
- Experience operating in a fast-moving, ambiguous startup environment.
- Strong judgment under ambiguity and with imperfect data.
- Clear and thoughtful communication skills for asynchronous and live collaboration.
Responsibilities
- Champion Sana's payer-side clinical strategy, ensuring coverage policies and utilization decisions are evidence-based.
- Build and lead a clinician-led team for complex case management, utilization management, and high-cost claimant review.
- Drive strategy and implementation of cost containment initiatives and benefit design.
- Support the Operations team and PBM partner to drive evidence-based pharmacy cost initiatives.
- Partner with Underwriting to assess clinical risk for employer groups.
- Work with Analytics to support medical economics and population health initiatives.
- Serve as a clinical voice in the design of internal payer tools and coverage engines.
- Evolve case management KPIs and reporting structures.
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