• Conduct utilization and medical necessity reviews using benefit language, medical policies, and evidence-based guidelines • Apply benefit interpretation to ensure accurate, compliant, and well-supported determinations • Prepare detailed documentation that meets regulatory, accreditation, and internal quality standards • Participate in peer-to-peer conversations with treating clinicians when required • Work collaboratively with Medical Directors across regions and specialties to support consistent clinical decision-making

• Stand up and run daily clinical operations • Translate program requirements into repeatable care workflows • Define the care team structure • Ensure billing-ready documentation is completed correctly • Operate a controlled pilot with volume caps • Create onboarding and training for care team members • Define escalation pathways and ensure SLAs are met • Define what the clinical team needs in workflows

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. 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.

• Provide virtual medical direction and oversight for mid-level providers delivering telehealth hormone and weight-loss services • Review and sign off on 10 patient charts per provider per month • Be available by phone or telecommunication for consultation if needed • Ensure compliance with all clinical, ethical, and regulatory standards