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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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LTC Care Coordinator

NY Req ID: R022463 Remote
Duties and Responsibilities: Receive incoming calls from members regarding benefit questions/issues, care coordination, program inquiries, connecting to their care manager, and screening assessments to identify risk factors requiring medical interventionContemporaneously and accurately documents...
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Clinical Quality Specialist

NY Req ID: R022439 Hybrid
Duties & Responsibilities:Performs HEDIS medical record review, abstraction, data entry and validation activities in accordance with NCQA guidelines and organizational policies.Reviews and validates clinical documentation and coding from electronic medical records (EMRs), provider records,...
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Support Coordinator - Spanish Fluency

NY Req ID: R022135 Remote
Duties and Responsibilities: Provides excellent quality customer service to our members and/or providers relating to authorization updates, questions/issues such as coordinating care, DME outreach, scheduling appointments, and screen assessments to identify risk factors which need closer...
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TL QA Auditor

FL Req ID: R022393 Hybrid
Responsibilities: Manages a team of quality auditors, with the responsibility for monitoring inventory and productivity, coaching and providing feedback, performance management and other leadership responsibilities as assigned. Conducts regular 1x1 meetings to understand the team’s needs and...
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Field Entitlement Advocate

NY Req ID: R022445 Hybrid
Duties and ResponsibilitiesSHP Renewal Line: (Inbound/Outbound)Handle 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...
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Bilingual Senior Retention Advocate

NY Req ID: R022331
Contacts members and/or primary caregivers by phone or letter to arrange a telephonic or in-person interview to assess Medicaid/Medicare/Medicare Savings Program eligibility. Ensures all calls and conversations are conducted in accordance with approved Healthfirst expectations. Educates and...
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Hospital Strategic Account Manager II

NY Req ID: R022214 Hybrid
Responsibilities:Leading a team of Hospital Specialists in a Matrix environmentDocument and recommend changes to existent processes as part of workflow redesign to align to new Strategic Account Management structureCoordinate account activity and workflow, including but not limited to the...
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Driver (CDL 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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