Healthfirst

Instructional Designer

NY  |  Req ID: R021200  |  Remote

Scope of Responsibilities:Partner with senior instructional designer or other learning leader to identify learning objectives, gather requirements, define outcomes, and establish evaluation measures and success metrics.Engage in a collaborative development process ensuring to partner with SME’s,...

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Support Coordinator

NY  |  Req ID: R021245  |  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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UM Pharmacy Technician-1

NY  |  Req ID: R021182  |  Remote

Duties & Responsibilities:Reviews prior authorization requests and units for medications requested under the medical benefitAssesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteriaSends notification to members and providers of...

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Sr Data Engineer

FL  |  Req ID: R021228  |  Remote

Duties and Responsibilities:Designs and implements standardized data management procedures around data staging, data ingestion, data preparation, data provisioning, and data destruction (e.g., scripts, programs, automation, etc.)Ensures quality of technical solutions as data moves across multiple...

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Director, Performance Improvement

NY  |  Req ID: R021186  |  Hybrid

Duties & Responsibilities:Partners closely with operations and the business to establish, publish, and execute a strategy for PI initiatives within and between core processes.Works with PI teams to develop programs and projects based upon business user and business impacts (i.e. reduce...

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Medical Peer Reviewer

NY  |  Req ID: R021188  |  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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Bilingual Mandarin Cantonese Field Care Coordinator Long Island

NY  |  Req ID: R021193  |  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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Bilingual Mandarin Cantonese Field Care Coordinator Westchester

NY  |  Req ID: R021194  |  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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Bilingual Korean Field Care Coordinator Queens

NY  |  Req ID: R021110  |  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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Clinical Navigation Team Mgr Care Mgmt

NY  |  Req ID: R020999  |  Remote

Duties//Responsibilities:·        Develops and monitors team goals; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; routinely evaluates staff’s clinical skills and technical comprehension; and ensures an atmosphere of open communication, teamwork,...

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Manager Assessment Nurse

NY  |  Req ID: R021008  |  Hybrid

Duties and Responsibilities: Leads and manages daily Reassessment Nurse operations such as overseeing scheduling and staffing, providing clinical consultations, and ensuring departmental productivity goals are met in regards to quality, timeliness, accuracy, and consistency.Coordinates and...

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Support Specialist Bilingual English Mandarin or Cantonese

NY  |  Req ID: R020852  |  Remote

Duties and Responsibilities: Conduct outreaches for newly enrolled members to review current and approved services, durable medical equipment (DME) and additional requestsReview intake documents for pre-approved services and escalate discrepancies as neededComplete Welcome Onboarding and Consumer...

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Field Service Agent - Jackson Heights/Queens (Bilingual English/Spanish)

NY  |  Req ID: R021248  |  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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Field Service Agent - Jamaica/Queens (Bilingual English/Spanish)

NY  |  Req ID: R021217  |  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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Field Service Agent (Mandarin/Cantonese)

NY  |  Req ID: R020920  |  On-site

Must be able to commute across multiple counties and boroughs: including Manhattan, Brooklyn and Queens boroughs. 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,...

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Vice President, Enterprise Procurement

NY  |  Req ID: R021136  |  Hybrid

Duties & Responsibilities:Establish and lead a high-performing sourcing and procurement organization, including the recruitment, development, and retention of top talent.Collaborate with senior leadership to develop a comprehensive sourcing and procurement strategy that aligns with the...

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AVP, Corporate Compliance

NY  |  Req ID: R020940  |  Hybrid

Hybrid Work ScheduleThis position requires three days per week in the office at 100 Church Street, NYC (Tues/Wed/Thurs).Duties and ResponsibilitiesLeadership point of contact and subject matter expert on all compliance related matters; provides guidance to leadership and the Compliance team...

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Director, Organizational Design and Strategic Workforce Planning

NY  |  Req ID: R017823  |  Hybrid

Duties and ResponsibilitiesPrimary designer and lead on a variety of enterprise OD and OE initiatives focused on, but not limited to, Organizational Design and Strategic Workforce Planning.Develop the enterprise approach, frameworks, and tools to implement organizational design and strategic...

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Care Manager, RN - Restricted Recipient Program

NY  |  Req ID: R021102  |  Remote

Duties//Responsibilities of the Restricted Recipient Program:Oversees the care management of members in the NYS RRP who require tightly managed access to medical services due to their historic misuse//abuse of Medicaid program resources.Conducts medical reviews of member usage patterns analyzing...

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Bilingual Pediatric Care Manager

NY  |  Req ID: R020904  |  Remote

**This position is 100% RemoteDuties/Responsibilities:The Pediatric Care Manager plans and manages pediatric medical and/or behavioral care with members and their beneficiaries across the continuum of care. The Care Manager is assigned to a specific product line such as PHSP, Child Health Plus,...

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