Healthfirst

Senior Manager Clinical Eligibility

NY  |  Req ID: R021813  |  Hybrid

Duties & Responsibilities:  Participates in all aspects of personnel management to ensure appropriate staffing, orientation, support, discipline, and timely performance appraisals.Meets regularly with direct reports to review goals, trends, and performance measures and to facilitate...

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Medical Peer Reviewer

NY  |  Req ID: R021699  |  Remote

Duties/Responsibilities:·The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations.·The Medical Peer Reviewer will render determinations in the...

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Director, Utilization Management

NY  |  Req ID: R021977  |  Hybrid

Duties/Responsibilities:Provide strategic direction and leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requestsDevelop strong operational and leadership capabilities within the organization through performance...

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Regulatory Specialist

VA  |  Req ID: R022103  |  Remote

DescriptionMeets with the Regulatory department to organize pre-survey deliverables and conduct reviews of materials.Interacts with and represents the business unit.Responds to auditor requests and audits outcome results.   Identifies organizational risks and helps implement process...

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Utilization Management Manager

NY  |  Req ID: R022096  |  Remote

Duties/Responsibilities:Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, referrals, and other plan servicesDevelops and monitors goals for staff; provides ongoing feedback and coaching; conducts annual performance...

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Field Assessment Registered Nurse, Bronx, NY - $10,000 Sign-On Bonus (Spanish)

NY  |  Req ID: R021989  |  Hybrid

Duties and Responsibilities: ·       Conducts home assessments (and virtual assessments, as needed) for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and...

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Application Developer/Manager, Digital Provider Collaboration Program

FL  |  Req ID: R022111  |  Remote

Duties: Serve as a Qlik Cloud /QlikSense developer/Admin comfortable with the creation of reports / dashboards & extracts using transformation via multi-layered backend data models as well as front end dashboards or reports using Qlik technology platform (or similar) which includes Qlik...

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AVP, Community Engagement

NY  |  Req ID: R021917

This is a hybrid position which consists of reporting to our 100 Church Street, NYC office 3 days per week (Tuesdays, Wednesdays & Thursdays).Responsibilities:Develop, align, and implement a community partnerships strategy that promotes Healthfirst in the targeted communities by working with...

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Field Service Agent - Queens - Bilingual Mandarin/Cantonese

NY  |  Req ID: R022070  |  On-site

**Preferred Bilingual Mandarin and/or Cantonese Job DescriptionDuties/Responsibilities:Provide high-quality customer service to providers and members across all LOBs with a variety of questions and issues on topics such as eligibility, benefits, claims process, escalations, and productsManage...

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Field Service Agent - Brooklyn - Mandarin/Cantonese

NY  |  Req ID: R022068  |  On-site

**Preferring Bilingual Mandarin and/or Cantonese for the Brooklyn locationJob DescriptionDuties/Responsibilities:Provide high-quality customer service to providers and members across all LOBs with a variety of questions and issues on topics such as eligibility, benefits, claims process,...

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CCO Service Agent – Bilingual - 100% Remote

NY  |  Req ID: R021945  |  Remote

**This position is 100% remoteHealthfirst has multiple openings for CCO Agents for different languages to support our members.  We are seeking agents that have Russian or Mandarin/Cantonese or Spanish skills that are bilingual.Duties and Responsibilities Provides excellent quality customer...

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Field Service Agent - Manhattan (Bilingual English/Spanish)

NY  |  Req ID: R021652  |  On-site

Duties/Responsibilities:Provide high-quality customer service to providers and members across all LOBs with a variety of questions and issues on topics such as eligibility, benefits, claims process, escalations, and productsManage face-to-face encounters by interacting with customers to provide...

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Director Customer Experience Strategy

NY  |  Req ID: R021874  |  Hybrid

Experience Strategy Development & Execution:Lead the development and ongoing evolution of the Medicaid customer experience strategy, aligned with organizational priorities, regulatory requirements, and member needsEstablish elements of mid-term experience strategies and operational plans for...

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Bilingual Sales Operations Service Agent (Spanish and/or Mandarin/Cantonese

NY  |  Req ID: R022124  |  Remote

Duties & Responsibilities:Provides high quality on-line and telephone assistance to all customers including brokers/agent and their uplinesProvides high quality handling of customer inquiries, via mail, e-mail and chat sessionsResolves inquiries and issues relating to all aspects of broker/...

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Fleet CDL Driver (Class A, B or C )

NY  |  Req ID: R022067  |  On-site

Checks the interior and exterior of the vehicle for cosmetic and operational concerns.Performs minor maintenance tasks on the vehicle when necessary, included but not limited to daily vehicle inspections and the inspection of all engine fluids.Maintains confidentiality by keeping all potential...

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Ancillary Services Network Account Manager I

NY  |  Req ID: R021927  |  Hybrid

Manage a network of Ancillary Providers for all lines of Healthfirst's business (such as Medicaid, CHP, Medicare, and Commercial). Monitor and audit contracted ancillary providers to ensure that accurate demographic, payment and fee schedules are loaded into the HF Provider System...

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Broker Sales Support Associate

NY  |  Req ID: R021940  |  Hybrid

Description and RequirementsThe Sales Support Associate is responsible for positioning Healthfirst as a socially responsible health partner. S/he will develop and coordinate plans of action that promote company-wide enrollment through promotions, events, sponsorships and collaboration with...

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Field Entitlement Enrollment Advocate - Bilingual Spanish or Man/Can

NY  |  Req ID: R021640  |  Hybrid

Duties and ResponsibilitiesHandle inbound and outbound calls to and from customers to address their needs while adhering to our service level goals.Screen all incoming calls and handles accordingly.Transfer calls to appropriate staff, unit, or department.Assist callers requesting assistance with...

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Senior Network Account Manager

NY  |  Req ID: R021405  |  Hybrid

· Advance Healthfirst through superior customer service focused leadership in an assigned territory and team, which will help to optimize provider satisfaction· Educate and train network representatives in key business principles around profitability, network adequacy, quality, etc.· Promote...

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Manager, Medicaid Strategic Initiatives

NY  |  Req ID: R022003  |  Hybrid

Identify key member cohorts and opportunities for achieving short- and long-term membership retention improvement strategiesAssist in the development of a member retention strategy through the use of segmentation modeling, member profiling, propensity scoring and targeted channel...

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