Florida Blue

Care Coordinator

Florida Blue · Full Time · 11 hours ago

Florida Blue

🌎 United States ⭐ 0-2 yrs exp 💼 Healthcare

The Care Coordinator supports non-clinical healthcare operations by serving as a resource for patients, families, and providers while managing telephonic follow-ups. They assist RN Case Managers with administrative tasks, data entry, and the coordination of patient healthcare goals.

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Claims Examiner I

Florida Blue · Full Time · 18 hours ago

Florida Blue

🌎 United States ⭐ 2-5 yrs exp 💼 Legal

The Claims Examiner is responsible for the day-to-day processing and adjudication of medical, dental, vision, and mental health claims. They also conduct claims research, investigate overpayments, and facilitate settlements while maintaining compliance with policy guidelines.

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Part Time Concurrent Review Nurse

Florida Blue · Full Time · 6 days ago

Florida Blue

🌎 United States 💵 $71200 - $115K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Concurrent Review Nurse performs medical reviews to ensure members receive appropriate care and facilitates smooth transitions from facilities to home. They serve as a point of contact for providers, coordinate discharge planning, and identify candidates for specialized care programs.

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Concurrent Review Nurse

Florida Blue · Full Time · 6 days ago

Florida Blue

🌎 United States 💵 $71200 - $115K per year ⭐ 2-5 yrs exp 💼 Healthcare

The Concurrent Review Nurse performs medical reviews to ensure appropriate care levels and facilitates discharge planning to reduce readmissions. They serve as a primary point of contact for providers and collaborate with medical directors and case managers to coordinate member care.

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Service Advocate V (Appeals & Disputes)

Florida Blue · Full Time · 6 days ago

Florida Blue

🌎 United States 💵 $20 - $33 per hour ⭐ 2-5 yrs exp 💼 Others

The Service Advocate reviews and resolves member and provider appeals, grievances, and disputes in accordance with regulatory guidelines and company policies. They are responsible for researching claim issues, documenting findings in SQL databases, and communicating final determinations to stakeholders within strict timelines.

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RN Maternity Case Mgr

Florida Blue · Full Time · 8 days ago

Florida Blue

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

The RN Maternity Case Manager assesses the health status of expectant mothers and coordinates care plans to manage healthcare costs. Responsibilities include monitoring high-risk pregnancies, identifying cost-effective resources, and collaborating with providers and families.

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Care Mgmt Referral Analyst RN

Florida Blue · Full Time · 8 days ago

Florida Blue

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

The RN Referral Analyst reviews and assesses referrals from various sources to assign appropriate medical case management based on acuity and clinical data. They also identify alternate care outreach plans for members who do not meet full case management criteria.

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Utilization Management RN

Florida Blue · Full Time · 8 days ago

Florida Blue

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

The UM Nurse is responsible for pre-certification, concurrent review, and discharge planning to ensure medical necessity and cost-effective care. They collaborate with providers and members to optimize health outcomes while adhering to benefit plan provisions.

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RN Case Manager

Florida Blue · Full Time · 9 days ago

Florida Blue

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

The RN Case Manager creates, implements, and monitors treatment plans to help members meet their healthcare goals. Responsibilities include assessing health status, coordinating care with providers, and ensuring cost-effective service delivery.

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Clinical Finance - Care Delivery Assets Director

Florida Blue · Full Time · 22 days ago

Florida Blue

🌎 United States 💵 $136K - $221K per year ⭐ 10+ yrs exp 💼 Finance

Serve as a financial strategist and benchmarking authority to drive margin improvement and operational efficiency across a portfolio of care delivery assets. The role involves translating clinical operational decisions into financial impacts and providing strategic guidance to asset-level leadership.

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Senior Director - Marketing & Engagement ACA

Florida Blue · Full Time · a month ago

Florida Blue

🌎 United States 💵 $126K - $204K per year ⭐ 10+ yrs exp 💼 Marketing

Lead the strategy and execution of GuideWell's acquisition marketing programs while serving as the primary strategic representative for the CMX department to the Government ACA segment. Orchestrate integrated solutions across communications, brand, and customer experience to drive enrollment and business growth.

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Assistant General Counsel - Corporate Governance

Florida Blue · Full Time · a month ago

Florida Blue

🌎 United States 💵 $180K - $292K per year ⭐ 10+ yrs exp 💼 Legal

Provide specialized legal counsel and comprehensive governance support to the Board of Directors and its committees. Manage board materials, update governance policies, and advise on regulatory requirements and risk management.

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Principal Cloud Architect

Florida Blue · Full Time · a month ago

Florida Blue

🌎 United States 💵 $180K - $292K per year ⭐ 10+ yrs exp 💼 Software Development

Establish and execute the organization's multi-year cloud transformation vision as the principal technical authority for the C-suite. Lead the Cloud Center of Excellence to drive enterprise-wide adoption, optimize costs via FinOps, and mentor high-performing technical teams.

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Mid Market Account Executive - Renewal (South, Florida)

Florida Blue · Full Time · 2 months ago

Florida Blue

🌎 United States 💵 $93000 - $151K per year ⭐ 2-5 yrs exp 💼 Sales

Develop and implement renewal strategies for groups of 50-499 employees to ensure client retention. Build and maintain strong partnerships with insurance agents and internal stakeholders to facilitate the sales and enrollment process.

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Principal Cloud and AI Security Architect

Florida Blue · Full Time · 2 months ago

Florida Blue

🌎 United States 💵 $138K - $224K per year ⭐ 5-10 yrs exp 💼 Software Development

Drive enterprise-wide technology security strategy with a focus on implementing innovative AI and cloud security solutions. Lead the secure design of cloud foundational controls and manage the migration from on-premise datacenters to public cloud environments.

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VP Customer Experience (CX) & Engagement

Florida Blue · Full Time · 5 months ago

Florida Blue

🌎 United States ⭐ 10+ yrs exp 💼 Support

This executive role is responsible for transforming how GuideWell, Florida Blue, and Triple-S engage with stakeholders by leading the design of health-centric member experiences and developing enterprise-wide CX strategy, governance, and capability. Key duties include leading end-to-end journey design across channels, championing AI for personalization, and establishing a unified CRM and communications strategy.

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VP AI Engineering

Florida Blue · Full Time · 5 months ago

Florida Blue

🌎 United States ⭐ 10+ yrs exp 💼 Software Development

This executive role involves owning the architecture, development, and operation of platforms powering AI-driven innovation across the health plan enterprise, focusing on transforming operations from predictive models to automation in areas like claims and care management. Key duties include executing the multi-year technical roadmap, serving as the senior engineering authority for AI, and ensuring production-grade AI systems are scalable, compliant, and clinically sound.

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Medical Director Care Management

Florida Blue · Full Time · 6 months ago

Florida Blue

🌎 United States 💵 $224K - $364K per year ⭐ 5-10 yrs exp 💼 Healthcare

The Medical Director will conduct various utilization management reviews, including pre-service, post-service, concurrent review, and appeals, while discussing cases with physician providers. Key duties involve applying health plan criteria to render timely medical necessity decisions and collaborating with Case Managers for physician assistance.

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