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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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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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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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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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CCO Service Agent - 100% Remote

NY Req ID: R021943 Remote
Duties and Responsibilities Provides excellent quality customer service to our members and/or providers relating to all aspects of member/provider questions and issues such as eligibility, benefits, claims process, escalations, and product questions, etc. May include but is not limited to...
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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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Ancillary Network Account Manager

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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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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Healthcare Strategy Associate (Hybrid NY)

NY Req ID: R021959 Hybrid
Responsibilities:•Support identifying areas of profitable growth opportunity•Assist in developing and implementing planned improvements•Support identifying key cohorts and opportunities for achieving short- and long-term membership growth and retention across product lines•Work collaboratively...
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