Hybrid Clinical Authorization Platform Consultant

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

Benefits offered by this job

Medical insurance

Retirement plan

Paid time off

Wellness program

Job summary

Florida Blue seeks a Clinical Consultant to translate approved medical policy and utilization criteria into platform requirements, validate outputs, and ensure regulatory readiness. You will collaborate with Medical Directors, Compliance, Legal, Product, Engineering, Analytics, and AI safety teams to align clinical governance with the Authorization Platform.

This hybrid role involves preparing clinician readiness materials, guiding internal adoption, and supporting external partner integrations

Qualifications

• 6+ years of related work experience in utilization management or payer/provider environments.
• Clinical credential or equivalent clinical operations background.
• Strong understanding of medical policy development and regulatory requirements.

Responsibilities

• Translate clinical policy and criteria into platform requirements and decision logic.
• Validate outputs against policy, historical decisions, and documentation standards.
• Develop clinical validation plans, testing rubrics, and validation summaries.
• Collaborate with cross-functional teams to ensure governance and regulatory readiness.
• Create escalation criteria and human-review processes for high-risk cases.
• Support clinician adoption and communicate platform limitations and workflow impact.

Skills

Clinical policy

Utilization management

Prior authorization

Health informatics

Education

Bachelor's degree

Clinical credential (RN/MD/DO)

Tools

HL7/FHIR knowledge

Job description

Florida Blue seeks a Clinical Consultant to translate approved medical policy and utilization criteria into platform requirements, validate outputs, and ensure regulatory readiness. You will collaborate with Medical Directors, Compliance, Legal, Product, Engineering, Analytics, and AI safety teams to align clinical governance with the Authorization Platform.

This hybrid role involves preparing clinician readiness materials, guiding internal adoption, and supporting external partner integrations