Clinical Consultant Authorization Platform

GuideWell • Jacksonville, FL

5d • Hybrid

About The Position

The Clinical Consultant provides clinical translation, validation, and adoption support for the Authorization Platform. This role ensures approved medical policy, utilization management criteria, and clinical workflow expectations are accurately reflected in platform design while maintaining appropriate human oversight, clinical defensibility, and regulatory readiness. The Clinical Consultant uses technical knowledge in influencing and collaborating and negotiating with internal stakeholders (functional subject matter experts and senior executives) as well as external provider systems and health plan partners to ensure understanding of requirements needed to advance, automate, and transform the authorization process and platform.

Requirements

• 6+ years related work experience.
• Experience in utilization management, care management, prior authorization, medical policy, clinical quality, clinical operations, or related payer/provider environment.
• Expert level health informatics
• Related Bachelor’s degree or additional related equivalent work experience
• Clinical credential or equivalent clinical operations background (RN, MD, or DO), or senior clinical operations leader)
• Strong understanding of medical policy development and interpretation, evidence-based medicine, clinical criteria, authorization workflows, documentation standards, and and clinical governance
• Demonstrated ability to identify and mitigate clinical and operational risks in healthcare systems
• Experience with healthcare data standards (ANSI, HL7, FHIR, or similar) and interoperability requirements
• Experience translating clinical requirements into operational workflows, system requirements (technical specifications and validation rules), decision support logic, or technology-enabled process design
• Knowledge of healthcare compliance, regulatory requirements, and quality standards
• Demonstrated experience in building productive relationships with various internal and external stakeholders and partners including provider systems and health plan senior executives, medical directors, and subject matter experts

Nice To Haves

• Experience with healthcare technology, health / clinical informatics, AI-enabled tools, quality improvement, regulatory readiness, or implementation of new clinical workflows
• Experience with AI/ML model validation from a clinical perspective (bias detection, outcome validation, safety testing)
• Familiarity with testing methodologies and prompt injection risks in clinical AI systems
• Experience designing human-in-the-loop workflows and escalation protocols for clinical decisions
• Understanding of data governance, sensitive data classification, and privacy-preserving analytics in healthcare
• Prior involvement in multi-stakeholder healthcare initiatives or interoperability projects
• Experience with agile or iterative development methodologies

Responsibilities

• Translates approved medical policy, utilization management criteria, benefit rules, and clinical guidelines into clear platform requirements and decision logic
• Supports development of decision trees, escalation pathways, clinical guardrails, and case-handling rules for priority authorization use cases
• Designs clinical requirements and decision logic documentation for priority authorization use cases
• Validates platform outputs against approved policy, historical decision patterns, clinician expectations, and documentation standards
• Builds clinical validation plan, testing rubric, and summary of validation findings
• Partners with Medical Directors, Compliance, Legal, Product, Engineering, Analytics, and AI safety teams to support governance, human oversight, bias monitoring, and regulatory readiness
• Identifies clinical risks, unclear reasoning, inappropriate automation, workflow gaps, and policy interpretation issues requiring escalation
• Creates escalation and human-review criteria for complex, uncertain, or high-risk cases
• Develops issue log to monitor and document policy gaps, clinical exceptions, accuracy and safety concerns, and required decisions
• Supports clinician adoption internally and across partner organizations by explaining platform purpose, limitations, required human review, workflow impact, and safe-use expectations
• Serves as the clinical subject matter expert bridging hospital systems, health plans, and technology teams to gather requirements, influence decision-making, and ensure solutions meet clinical and operational standards
• Creates clinician-facing readiness materials
• Delivers monthly senior executive leadership updates summarizing progress, risks, decisions needed, and launch considerations

Benefits

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits: life insurance, short- and long-term disability programs
• Leave programs to support personal circumstances
• Retirement Savings Plan including employer match
• Paid time off, volunteer time off, 10 holidays and 2 well-being days
• Additional voluntary benefits available
• A comprehensive wellness program
• Competitive pay
• Opportunities for incentive or commission compensation
• Regular annual reviews with pay for performance considerations for base pay increases

What This Job Offers

• Job Type: Full-time
• Career Level: Senior