Healthfirst

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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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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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...

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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...

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Senior Manager of Performance Improvement

FL  |  Req ID: R021599  |  On-site

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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Senior 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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Director, Clinical Operations Children's Services

NY  |  Req ID: R021718  |  Hybrid

Duties/Responsibilities:Provides leadership and directs the home and community-based services (HCBS) and case management program of the Children’s Services unit for Healthfirst members ages 0-21.Participates in all aspects of the team’s management and employee lifecycle to ensure appropriate...

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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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Clinical Peer Reviewer (Physical Therapy)

NY  |  Req ID: R021692  |  Remote

Duties and Responsibilities:Review complex prior authorization, concurrent review, and retrospective cases related to Outpatient Rehab services to promote member-centered decision making that supports functional improvements and quality health outcomes.Ensure all determinations are rendered...

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2026 Summer Internship - Nursing Intern

NY  |  Req ID: R021678  |  Hybrid

The program is also immersive and interactive, laying a foundation for continued leadership development. Interns do impactful work, collaborating with other interns, employees, and business leaders to solve current operational and clinical workflow challenges, strengthen member experience, and...

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Field Assessment Registered Nurse, Bronx, NY - $10,000 Sign-On Bonus (Spanish)

NY  |  Req ID: R021617  |  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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Senior Manager, Pharmacy Benefits

NY  |  Req ID: R021557  |  Hybrid

Duties & Responsibilities:Works collaboratively to design and manage the Healthfirst Pharmacy Benefit for all plansStrategically leads the development, planning and implementation of the annual pharmacy benefit cycle to ensure that pharmacy benefits are in-line with Healthfirst Product...

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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...

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Vice President, Contact Center Operations

NY  |  Req ID: R021784  |  On-site

This is a hybrid position which consists of reporting to our 100 Church Street, NYC office 3 days per week (Tuesdays, Wednesdays & Thursdays).Duties/Responsibilities:Establish and execute the long-term strategic roadmap for the Contact Center of the Future, leveraging AI-driven automation,...

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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...

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Field Service Agent - Manhattan (Bilingual English/Spanish)

NY  |  Req ID: R021652  |  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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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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Director, Delivery System Engagement (DSE) Network Optimization Program Management

NY  |  Req ID: R021837  |  On-site

Responsibilities:Develop and maintain the enterprise provider network optimization strategy and roadmap, aligned to organizational priorities.Provide structured recommendations, scenario framing, and trade-off analyses to inform decisions made by A/R, OON, and Contracting leadership.Translate...

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Director, Delivery System Innovation

NY  |  Req ID: R021574  |  On-site

Strategic Partnership & Innovation LeadershipIdentify, assess, and support the development of innovative delivery system partnerships with hospitals, provider organizations, and specialized vendors, including value-based and risk-bearing arrangementsServe as a strategic thought partner to DSI...

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