Clever Care Health Plan Visa Sponsorship Jobs USA
Clever Care Health Plan is a California-based Medicare Advantage insurer focused on serving diverse communities. The company has sponsored permanent residency pathways, making it a consideration for immigration professionals and healthcare operations candidates seeking Green Card sponsorship in the managed care sector.
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Get Access To All JobsINTRODUCTION
This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County.
Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
Who Are We? ✨
Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.
Why Join Us?
We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
Part Time: up to 25 hours per week
The Part-Time Medical Director provides physician review and clinical oversight for MAPD utilization management, care management, appeals and grievances, quality-of-care review, delegated clinical functions, and CMS audit readiness. This role is a good fit for someone who enjoys working closely with a team, talking through real cases and operational questions, and partnering with clinical and operational leaders to make timely, thoughtful, well-documented decisions that support members and providers while staying aligned with CMS and plan requirements.
Core Responsibilities
UM Reviews & Clinical Decision-Making
- Review UM cases where physician input is needed, including prior authorizations, secondary reviews, and medical necessity questions.
- Make thoughtful, medically appropriate decisions that balance clinical evidence, plan requirements, and the member’s individual needs.
- Use CMS rules, plan criteria, and clinical guidelines in a consistent and well-documented way.
- Support peer-to-peer discussions and help work through complex or escalated cases.
Care Management & Population Health
- Partner with Care Management and Population Health leadership to provide physician guidance on clinical programs, workflows, and member care strategies.
- Provide clinical oversight and physician guidance for Health Risk Assessments (HRAs), Individualized Care Plans (ICPs), Interdisciplinary Care Team (ICT) activities, and Transitions of Care (TOC) to ensure clinical appropriateness, regulatory compliance, and high-quality member care.
- Participate in discussions regarding complex member cases, barriers to care, and opportunities to improve care coordination and member outcomes.
- Collaborate on development of clinical programs focused on chronic disease management, preventive care, quality improvement, and health equity initiatives.
Appeals, Grievances & Quality-of-Care Review
- Review clinical appeals and grievances, including member, provider, and pharmacy-related cases.
- Participate in quality-of-care reviews, focused case reviews, and case discussions when physician input is needed.
- Make sure decisions are timely, clinically sound, and easy to follow in the documentation.
Delegation Oversight
- Provide physician oversight of delegated and internal clinical functions, including Utilization Management, Care Management, Pharmacy, Quality, Population Health, and SNP Model of Care activities. Participate in delegation assessments, performance monitoring, corrective action planning, and ongoing oversight.
- Participate in pre-delegation reviews, annual audits, CAP follow-up, and routine performance monitoring.
- Raise concerns early when there are clinical, compliance, quality, documentation, or member-safety issues.
CMS Audit & Committee Support
- Help prepare for and support CMS program audits, validation audits, mock audits, and other regulatory reviews.
- Review samples, determinations, documentation, and universes to make sure they are accurate and audit-ready.
- Participate in IRR, UM, Credentialing, P&T, QM, and other committees where physician input is needed.
- Serve as the physician representative during CMS, NCQA, and regulatory audits, including supporting audit interviews, universes, and corrective action plan development.
Working Across Teams
- Work collaboratively with the CMIO, Care Management, Population Health, Utilization Management, Pharmacy, Quality, Compliance, and Operations to align clinical priorities with operational workflows. Serve as an accessible physician partner who provides timely clinical guidance, supports process improvement initiatives, and helps resolve operational barriers while maintaining a member-centered approach.
- Flag potential FWA, compliance, quality, or documentation issues that come up through case review or oversight work.
Clinical Leadership
- Foster collaborative relationships with clinical and operational leaders to support organizational priorities and continuous improvement.
- Provide physician mentorship and consultation to nursing, pharmacy, and interdisciplinary teams.
- Champion a culture of quality, compliance, accountability, and member-centered care.
Qualifications
- MD or DO with active unrestricted medical license; board certification in Internal Medicine, Family Medicine, or Geriatrics preferred. Geriatrics training or experience with older adult populations is strongly preferred.
- 5+ years of Medicare Advantage experience preferred, ideally with prior Medical Director or Physician Advisor experience in a health plan, delegated group, IPA, or similar setting.
- Experience with UM, appeals, delegation oversight, CMS audits, coverage criteria, medical necessity review, and clinical documentation standards.
- Strong clinical judgment, clear written communication, and a collaborative style; enjoys staying connected to the team and helping solve day-to-day clinical and operational issues.
Success Measures
- Strong partnership with operational leaders.
- Timely physician support for clinical escalations.
- Successful CMS audit readiness and delegation oversight.
- Improved collaboration across Care Management, UM, Population Health, and Quality.
- Support of quality improvement initiatives that improve member outcomes.
Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.
LI-Hybrid
INTRODUCTION
This position operates on a hybrid work schedule. Candidate must reside in Los Angeles or Orange County.
Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.
Who Are We? ✨
Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.
Why Join Us?
We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
Part Time: up to 25 hours per week
The Part-Time Medical Director provides physician review and clinical oversight for MAPD utilization management, care management, appeals and grievances, quality-of-care review, delegated clinical functions, and CMS audit readiness. This role is a good fit for someone who enjoys working closely with a team, talking through real cases and operational questions, and partnering with clinical and operational leaders to make timely, thoughtful, well-documented decisions that support members and providers while staying aligned with CMS and plan requirements.
Core Responsibilities
UM Reviews & Clinical Decision-Making
- Review UM cases where physician input is needed, including prior authorizations, secondary reviews, and medical necessity questions.
- Make thoughtful, medically appropriate decisions that balance clinical evidence, plan requirements, and the member’s individual needs.
- Use CMS rules, plan criteria, and clinical guidelines in a consistent and well-documented way.
- Support peer-to-peer discussions and help work through complex or escalated cases.
Care Management & Population Health
- Partner with Care Management and Population Health leadership to provide physician guidance on clinical programs, workflows, and member care strategies.
- Provide clinical oversight and physician guidance for Health Risk Assessments (HRAs), Individualized Care Plans (ICPs), Interdisciplinary Care Team (ICT) activities, and Transitions of Care (TOC) to ensure clinical appropriateness, regulatory compliance, and high-quality member care.
- Participate in discussions regarding complex member cases, barriers to care, and opportunities to improve care coordination and member outcomes.
- Collaborate on development of clinical programs focused on chronic disease management, preventive care, quality improvement, and health equity initiatives.
Appeals, Grievances & Quality-of-Care Review
- Review clinical appeals and grievances, including member, provider, and pharmacy-related cases.
- Participate in quality-of-care reviews, focused case reviews, and case discussions when physician input is needed.
- Make sure decisions are timely, clinically sound, and easy to follow in the documentation.
Delegation Oversight
- Provide physician oversight of delegated and internal clinical functions, including Utilization Management, Care Management, Pharmacy, Quality, Population Health, and SNP Model of Care activities. Participate in delegation assessments, performance monitoring, corrective action planning, and ongoing oversight.
- Participate in pre-delegation reviews, annual audits, CAP follow-up, and routine performance monitoring.
- Raise concerns early when there are clinical, compliance, quality, documentation, or member-safety issues.
CMS Audit & Committee Support
- Help prepare for and support CMS program audits, validation audits, mock audits, and other regulatory reviews.
- Review samples, determinations, documentation, and universes to make sure they are accurate and audit-ready.
- Participate in IRR, UM, Credentialing, P&T, QM, and other committees where physician input is needed.
- Serve as the physician representative during CMS, NCQA, and regulatory audits, including supporting audit interviews, universes, and corrective action plan development.
Working Across Teams
- Work collaboratively with the CMIO, Care Management, Population Health, Utilization Management, Pharmacy, Quality, Compliance, and Operations to align clinical priorities with operational workflows. Serve as an accessible physician partner who provides timely clinical guidance, supports process improvement initiatives, and helps resolve operational barriers while maintaining a member-centered approach.
- Flag potential FWA, compliance, quality, or documentation issues that come up through case review or oversight work.
Clinical Leadership
- Foster collaborative relationships with clinical and operational leaders to support organizational priorities and continuous improvement.
- Provide physician mentorship and consultation to nursing, pharmacy, and interdisciplinary teams.
- Champion a culture of quality, compliance, accountability, and member-centered care.
Qualifications
- MD or DO with active unrestricted medical license; board certification in Internal Medicine, Family Medicine, or Geriatrics preferred. Geriatrics training or experience with older adult populations is strongly preferred.
- 5+ years of Medicare Advantage experience preferred, ideally with prior Medical Director or Physician Advisor experience in a health plan, delegated group, IPA, or similar setting.
- Experience with UM, appeals, delegation oversight, CMS audits, coverage criteria, medical necessity review, and clinical documentation standards.
- Strong clinical judgment, clear written communication, and a collaborative style; enjoys staying connected to the team and helping solve day-to-day clinical and operational issues.
Success Measures
- Strong partnership with operational leaders.
- Timely physician support for clinical escalations.
- Successful CMS audit readiness and delegation oversight.
- Improved collaboration across Care Management, UM, Population Health, and Quality.
- Support of quality improvement initiatives that improve member outcomes.
Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.
LI-Hybrid
Job Roles at Clever Care Health Plan
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Get Access To All JobsTips for Finding Clever Care Health Plan Visa Sponsorship Jobs USA
Target roles aligned with Green Card sponsorship
Clever Care Health Plan's sponsorship activity has focused on permanent residency pathways rather than temporary work visas. Prioritize applying for professional or technical roles where long-term retention matters to the employer, such as data analytics, compliance, or clinical operations positions.
Understand the EB-2 and EB-3 distinction
Clever Care sponsors both EB-2 and EB-3 Green Card categories. If your role requires an advanced degree or exceptional ability, EB-2 may apply. Otherwise, EB-3 covers skilled workers. Clarify with the hiring team which category your position would fall under.
Focus on healthcare operations and insurance functions
As a managed care organization, Clever Care's sponsorable roles tend to sit within healthcare administration, member services, compliance, and clinical coordination. Tailor your application to demonstrate expertise in these functions to align with their sponsorship history.
Ask about sponsorship early in the process
Because Clever Care's sponsorship activity is selective rather than high-volume, bring up visa requirements respectfully during the recruiter screening call. This avoids late-stage surprises and helps both sides assess fit before significant time is invested.
Search for verified sponsoring employers before applying broadly
Not every insurance company sponsors visas. To avoid wasted applications, use Migrate Mate to filter employers by real sponsorship history so you can focus your search on companies like Clever Care that have a confirmed track record of Green Card sponsorship.
Highlight long-term commitment to the U.S. market
Green Card sponsorship is a multi-year investment for any employer. In your cover letter and interviews, emphasize your intention to build a long-term career in U.S. managed care. Employers sponsoring permanent residency prefer candidates who demonstrate career stability and commitment.
Frequently Asked Questions
Does Clever Care Health Plan sponsor H-1B visas?
Based on available sponsorship data, Clever Care Health Plan does not have a history of sponsoring H-1B visas. Their sponsorship activity has been focused on permanent residency through the EB-2 and EB-3 Green Card categories. If you currently hold H-1B status with another employer, you would need to discuss Green Card sponsorship as the likely pathway with Clever Care's HR team.
What visa types does Clever Care Health Plan sponsor?
Clever Care Health Plan sponsors employment-based Green Cards, specifically under the EB-2 and EB-3 preference categories. EB-2 applies to professionals with advanced degrees or exceptional ability, while EB-3 covers skilled workers in roles requiring at least two years of training or experience. There is no indication of temporary nonimmigrant visa sponsorship such as H-1B or E-3 visa.
Which departments or roles at Clever Care Health Plan are most likely to receive visa sponsorship?
Given Clever Care's focus as a Medicare Advantage health plan, sponsorship opportunities are most likely to arise in roles requiring specialized expertise the company needs to retain long-term. This typically includes healthcare operations, data and analytics, compliance, clinical program management, and medical affairs. Roles requiring niche qualifications in managed care or value-based care are strong candidates for Green Card sponsorship consideration.
How do I find open sponsored jobs at Clever Care Health Plan?
The most efficient way is to use Migrate Mate, which surfaces verified sponsoring employers and lets you filter job listings by real sponsorship history. Rather than sifting through general job postings and guessing at sponsorship eligibility, you can browse Clever Care Health Plan's open roles directly and see their confirmed sponsorship track record in one place.
How do I approach the Green Card sponsorship conversation with Clever Care Health Plan during the hiring process?
Raise the topic during the recruiter screen rather than waiting until an offer stage. Frame it as a practical question: ask whether the role has been sponsored for permanent residency in the past and whether the company is open to supporting Green Card sponsorship for the right candidate. Coming in informed about EB-2 and EB-3 categories demonstrates seriousness and helps the recruiter route your question to HR quickly.