Clinical Authorization Platform Strategist

Florida Blue Group; Jacksonville (FL); Hybrid; USD 109,000 - 178,000; Full time

Benefits offered by this job

Hybrid work arrangement

Comprehensive benefits

Competitive pay

Job summary

Florida Blue Group in Jacksonville, FL seeks a Clinical Consultant to translate medical policy into platform requirements and ensure clinical governance for the Authorization Platform. The role collaborates with Medical Directors, Compliance, Legal, Product, Engineering, Analytics, and AI safety teams to support governance and regulatory readiness.

You will design decision logic, validate outputs, and develop validation plans, while guiding clinician adoption across partner organizations.

Qualifications

• Bachelor's degree or related equivalent work experience.
• Clinical credential or equivalent clinical operations background.
• Strong understanding of medical policy development and interpretation.

Responsibilities

• Translates approved policies into platform requirements and logic.
• Builds decision trees, escalation pathways, guardrails, and rules.
• Designs clinical requirements and decision logic documentation.
• Validates platform outputs against policy and clinician expectations.
• Develops validation plan, rubric, and findings summary.
• Partners with Medical Directors, Compliance, Legal, Product, Engineering for governance and regulatory readiness.

Skills

Utilization management

Care management

Prior authorization

Medical policy

Clinical quality

Clinical operations

Education

Bachelor's degree

Related equivalent experience

Tools

HL7

FHIR

ANSI

Job description

Florida Blue Group in Jacksonville, FL seeks a Clinical Consultant to translate medical policy into platform requirements and ensure clinical governance for the Authorization Platform. The role collaborates with Medical Directors, Compliance, Legal, Product, Engineering, Analytics, and AI safety teams to support governance and regulatory readiness.

You will design decision logic, validate outputs, and develop validation plans, while guiding clinician adoption across partner organizations.