Healthfirst

Sr. Manager, Performance Improvement

FL  |  Req ID: R021599  |  Hybrid

This position requires three days per week in office (Tues/Wed/Thurs) at either: 100 Church Street, NYC or 1101 Greenwood, Lake Mary, FL.Duties & Responsibilities:Identify, prioritize, and sponsor high-impact performance improvement initiativesDevelop business cases including financial...

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Finance Risk Analytics Intern (Financial Planning & Analysis) - 2026 Summer Internship

NY  |  Req ID: R021471  |  Hybrid

Duties & Responsibilities: Develop an understanding of the Healthfirst overall business and risk model, with a focus on how to support provider organizations to improve financial performance and how value-based care can drive improved outcomes Attend internal and external provider meetings to...

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HRBP Manager, IT – Hybrid NY

NY  |  Req ID: R021558  |  Hybrid

Scope of ResponsibilitiesProactively supports the delivery of all HR initiatives and processes.Builds a strong business relationship with the internal clients and serves as a key advisor and confidante, enabling strong management and leadership for the Department.Facilitates the design and...

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Peer Support Specialist - (NYCPS) New York Certified

NY  |  Req ID: R021594  |  Hybrid

Duties/Responsibilities:Manages designated caseload of members who could benefit from Peer Support services, care coordination, and health navigationSchedules and conducts multiple field-based visits per day (clustered by geographic areas)Completes assessments and questionnaires to identify...

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Appeals and Grievances Clinical Specialist

NY  |  Req ID: R021521  |  Remote

100% Remote - Work Schedule for this Role will be Wed-Sat from 7am-5:30pm. (4X10) Schedule.Duties and Responsibilities:Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay,...

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Appeals and Grievances Clinical Specialist

NY  |  Req ID: R021522  |  Remote

100% Remote - Work Schedule for this Role will be Wed-Sat from 7am-5:30pm. (4X10) Schedule.Duties and Responsibilities:Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay,...

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Appeals and Grievances Clinical Specialist

NY  |  Req ID: R021555  |  Remote

Job Description100% Remote - Work Schedule for this Role will be Wed-Sat from 7am-5:30pm. (4X10) Schedule.Duties and Responsibilities:Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification,...

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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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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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Medicare Outside Sales Representative

NY  |  Req ID: R021453  |  On-site

Duties & Responsibilities:Drive membership growth by acquiring new members while also meeting aggressive retention targets.Work directly with community-based organizations, providers, sales locations, and other sources to develop self-generated referral channels resulting in increased...

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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...

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QA Financial Auditor II

NY  |  Req ID: R021404  |  Remote

This position is 100% Remote. Scope of Responsibilities:Conduct moderately complex to complex quality audits of provider claims, pre-payments and post-payments including high-dollar and specialized claims across multiple lines of business, claim types and products.Audit the work of more junior...

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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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Sr Manager Clinical UM Operations - Hybrid NY

NY  |  Req ID: R021255  |  Hybrid

Duties/Responsibilities:Provide strategic oversight and operational management for all utilization management functions, including prior authorization, concurrent review, and service requestsLead, coach, and develop UM managers overseeing interdisciplinary teams of registered nurses, social...

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Provider Data Operations Representative

FL  |  Req ID: R021463  |  Remote

- Conducting comprehensive and thorough review of requests for Provider profile set-up and/or updates initiated by other departments and received via Macess, fax, or e-mail for accuracy and completeness.- Collaborating with internal and external customers to obtain any missing information...

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