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Director of Medical Reviews

Req ID: R021698 Hybrid
Duties & Responsibilities:The Medical Director 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 Director will render determinations in the...

Medical Peer Reviewer

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...

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...

AVP, Community Engagement

NY Req ID: R021830
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...

Field Service Agent - Queens

NY Req ID: R021771 On-site
** This position is for Field Queens locationBilingual Spanish preferredDuties/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...

Claims Coding Analyst

FL Req ID: R021325 Hybrid
Duties & Responsibilities: Conducts independent assessments of current claims edits to ensure comprehensive and defensible claims editing is in place across all Healthfirst product lines.Proactively identifies areas of opportunity with respect to new edits, modifications to existing edits,...
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