sanabenefits - Sana Benefits - Director, Care Management

• 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