Healthfirst

Appeals and Grievances Clinical Specialist

NY  |  Req ID: R021541  |  Remote

**This position is 100% remote, M-F 8am-5:30pm scheduleDuties and Responsibilities:Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of...

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Enterprise AI Architect

NY  |  Req ID: R021509  |  Remote

Duties & Responsibilities:Collaborates with all delivery programs to assess solution requirements, evaluate AI/ML technologies, and support model/vendor selection.Provides architectural guidance to business domain aligned delivered programs by defining and designing AI‑enabling technologies...

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Hybrid Assessment RN, Bronx, NY - $7,500 Sign-On Bonus (Spanish)

NY  |  Req ID: R021472  |  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...

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Internal Audit (Business) Intern

NY  |  Req ID: R021469  |  Hybrid

The Internal Audit Business/Ops Intern will have the opportunity to rotate through and work with the teams within the Internal Audit function: Business Operations, Model Audit Rule and Internal Controls.  As part of the internship, the Intern will have the opportunity to:  Interact with various...

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Hybrid Assessment RN, Bronx, NY - 7,500 Sign-On Bonus

NY  |  Req ID: R021473  |  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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Sr Project Manager - Utilization Management

NY  |  Req ID: R021498  |  Hybrid

Duties and ResponsibilitiesLead end-to-end delivery of complex, enterprise-wide (UM transformation) initiatives focused on operational efficiency, program transformation, technology enablement, and performance improvementDrive UM modernization efforts through implementation of AI, automation, and...

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Sr Credentialing Specialist (Temp)

NY  |  Req ID: R021517  |  Remote

Duties/ResponsibilitiesPerform primary source verifications and query necessary databases including but not limited to the following: CAQH, NPDB, NSCH, ABMS, AOA, AMA, etc.Perform credentialing and recredentialing of non-delegated providers and vendors, facilities and groups in accordance with...

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AVP Application Development -Enterprise Correspondence

NY  |  Req ID: R021476  |  Hybrid

Duties & Responsibilities:Provide overall IT leadership for Enterprise Correspondence Development teams. This includes support for initiatives, relationships with both internal and external parties, and providing expertise and counsel.Interface with all corporate and business unit leaders to...

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HIV/AIDS Care Manager - Hybrid NY - $3K Sign-On Bonus

NY  |  Req ID: R021488  |  Hybrid

​The Care Manager will provide care management services to vulnerable and high-risk Medicaid Members, including persons living with HIV/AIDS.  The Care Manager will reach out to members to identify barriers to care and medication adherence and will identify goals and interventions that improve...

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

NY  |  Req ID: R021474  |  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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Clinical Pharmacy Tech

NY  |  Req ID: R021425  |  Remote

Duties & Responsibilities:Performs review of medication lists to understand and eliminate barriers to medication therapy while serving as the member's Pharmacy Navigator to achieve proper medication adherence, minimize gaps in therapy, and prevent medication related adverse...

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2026 Technology Early Career Development Program - Data/Cloud Engineer

NY  |  Req ID: R021428  |  Hybrid

This position requires three days per week in office (Tues/Wed/Thurs) at 100 Church Street, NYC.For this role we are looking for candidates with project, internship or work experience with SQL and Python. Candidates should have fundamental knowledge and skills in data pipelining and cloud...

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2026 Technology Early Career Development Program - Data/Cloud Engineer

FL  |  Req ID: R021429  |  Hybrid

This position requires three days per week in office (Tues/Wed/Thurs) at Greenwood, Lake Mary, FL.For this role we are looking for candidates with project, internship or work experience with SQL and Python. Candidates should have fundamental knowledge and skills in data pipelining and cloud...

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2026 Technology Early Career Development Program – Quality Assurance/App Support

NY  |  Req ID: R021430  |  Hybrid

This position requires three days per week in office (Tues/Wed/Thurs) at 100 Church Street, NYC For this role we are looking for candidates with project, internship or work experience SQL, Java, C.  Candidates should have fundamental knowledge or skills in unit testing and databases....

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2026 Technology Early Career Development Program – Quality Assurance/App Support

FL  |  Req ID: R021431  |  Hybrid

This position requires three days per week in office (Tues/Wed//hurs) at 1101 Greenwood, Lake Mary, FL.For this role we are looking for candidates with project, internship or work experience SQL, Java, C.  Candidates should have fundamental knowledge or skills in unit testing and databases....

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2026 Technology Early Career Development Program – Product Owner/Business Analyst

NY  |  Req ID: R021432  |  Hybrid

This position requires three days per week in office (Tues/Wed/Thurs) at either: 100 Church Street, NYC   For this role we are looking for candidates with project, internship or work experience with business systems and processes and SDLC (Software Development Life Cycle). Candidates should have...

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QA Financial Auditor II

Req ID: R021404  |  Remote

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Clinical Technical Assistance Facilitator

NY  |  Req ID: R021284  |  Remote

Duties and Responsibilities:Leverages adult learning principles and clinical practice standards to move towards a culture of continuous technical assistance improvement and clinical capacity building with innovative learning solutions.Develops technical assistance goals that are congruent with...

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Field Care Coordinator Queens Korean Fluency

NY  |  Req ID: R021293  |  On-site

Duties/Responsibilities:Schedules and conducts multiple home visits per day (clustered in small geographic areas)Supports the Healthfirst clinical team members, including UAS nurses and Care Managers, by facilitating cross-cultural communications and interpreting the employee-to-member and...

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Director Utilization Management

NY  |  Req ID: R021231  |  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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