Clinical Authorization Platform Specialist

WEB-TPA, Inc.; Jacksonville (FL); Hybrid; USD 109,000 - 178,000; Full time

Benefits offered by this job

Health insurance

401(k) with match

Paid time off

Hybrid work arrangement

Job summary

Florida Blue seeks a Clinical Consultant to translate medical policy into platform requirements, validate outputs, and support adoption across partner health plans. The role collaborates with Medical Directors, Compliance, Legal, Product, Engineering, Analytics, and AI safety teams to ensure regulatory readiness.

The position requires 6+ years in utilization management or related fields, clinical credentials, and strong knowledge of policy development.

Qualifications

• 6+ years in utilization management, care management, or related payer environment
• Bachelor's degree or equivalent work experience
• Clinical credential (RN/MD/DO) or senior clinical operations background
• Strong knowledge of medical policy development and authorization workflows
• Experience with healthcare data standards (HL7, FHIR) and interoperability

Responsibilities

• Translate policy into platform requirements and decision logic
• Develop decision trees and escalation pathways for priority authorizations
• Validate outputs against policy and historical decisions
• Collaborate with internal and external stakeholders to ensure regulatory readiness
• Deliver monthly leadership updates on progress and risks

Job description

Florida Blue seeks a Clinical Consultant to translate medical policy into platform requirements, validate outputs, and support adoption across partner health plans. The role collaborates with Medical Directors, Compliance, Legal, Product, Engineering, Analytics, and AI safety teams to ensure regulatory readiness.

The position requires 6+ years in utilization management or related fields, clinical credentials, and strong knowledge of policy development.