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Role Description

Sana’s vision is simple yet bold: make healthcare easy. We aim to create an experience that feels easy when accessing our healthcare system. If you feel passionate about delivering better healthcare to small businesses through a seamless care experience and affordable benefits, join us!

We’re looking for a Medical Director, Health Plan to own the clinical strategy of our health plan and ensure the care our members receive is both high quality and cost-effective. This role is the clinical authority on the payer side of the house, accountable for:

• Coverage policies
• Utilization decisions
• Case management
• Pharmacy strategy
• Cost containment initiatives
• Network design

Reporting to the VP of Operations, you will be a key partner to Claims, Underwriting and Actuarial, Network Development, Finance, Revenue, and Product & Engineering. You will work closely with our Chief Medical Officer and virtual primary care team to ensure alignment between payer strategy and care delivery.

What you will do:

• Own Sana’s clinical strategy as a payer, defining how clinical standards, coverage policies, utilization decisions, and pharmacy strategy translate into high-quality, cost-effective care.
• 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.
• Partner closely with the operations team and our PBM partner to design evidence-based cost containment programs.
• Partner with Underwriting to assess clinical risk in quoting and pricing both prospective and renewing employer groups.
• Set and evolve evidence-based coverage guidelines, benefit design, and formulary policy aligned with high-value outcomes.
• 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 cost containment program reporting structures to measure efficacy and ROI.

Qualifications

• An MD or DO with board certification.
• Licensed to practice in Texas or willing to obtain licensure.
• 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 reimbursement for state licensure renewals and continuing education units (CEUs).
• 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.

Company Description

Founded in 2017, Sana is a health plan solution built for small and midsize businesses — designed around our integrated primary care service, Sana Care. We’ve been remote-first since day one, with a fully distributed team across the U.S. We value curiosity, ownership, and speed — and we build in the open, together.