Healthfirst

Director, Out-of-Network Contracting

NY  |  Req ID: R021566  |  Hybrid

This position requires three days per week in office (Tues/Wed/Thurs) at 100 Church St. New York, NY. ResponsibilitiesSet the enterprise strategy for Out-of-Network contracting, including rate methodologies, provider segmentation, and conversion strategies to bring high-utilization OON providers...

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AVP, Customer Experience Strategy - Medicare

NY  |  Req ID: R021418  |  On-site

Principal AccountabilitiesStrategy Development and Execution:Lead the creation and implementation of the Medicare customer experience strategy aligned with business objectives and regulatory requirementsOwn and evolve the Medicare member journey portfolio, identifying key moments that matter and...

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Strategic Account Management Associate

NY  |  Req ID: R021872  |  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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Appeals and Grievances Quality Assurance Auditor

Req ID: R021477  |  Remote

Conduct quality audits of A&G items including grievances, pre-service appeals, and post service appeals utilizing appropriate sources of information; including eligibility, claims, authorizations, service forms, faxes, and any additional information required to complete the request. Analyze...

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FQHC Network Account Manager

NY  |  Req ID: R021643  |  Hybrid

Serve as plan liaison for physicians/physician groups in a specified geographical area. Will be the main point of contact for all plan related issues including marketing, enrollment, contracting, billing and reimbursement.Responsible for the resolution of all issues, including those identified by...

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Entitlement Advocate- Bilingual Spanish or Cantonese/Mandarin

NY  |  Req ID: R021640  |  Hybrid

Duties and ResponsibilitiesHandle inbound and outbound calls to and from customers to address their needs while adhering to our service level goals.Screen all incoming calls and handles accordingly.Transfer calls to appropriate staff, unit, or department.Assist callers requesting assistance with...

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Healthcare Strategy Associate - Hybrid NY

NY  |  Req ID: R021801  |  Hybrid

Job DescriptionDuties and Responsibilities:· Conduct quantitative and qualitative analyses using Excel to support business and strategic decisions· Manage and track projects end-to-end, including timelines, deliverables, and stakeholder coordination· Assist in developing and executing strategic...

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Community Office Coordinator

NY  |  Req ID: R021752  |  On-site

Job Responsibilities/DutiesImprove overall member experience and reduce waiting time in order to expedite traffic flowRegister and educate members in the HF Member portal (access online services)Audit and Review applications to ensure quality and reduce rejectionsConduct training to...

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State Programs Member Engagement Specialist (Facilitated Enrollment)

NY  |  Req ID: R021763  |  On-site

Engage in enrollment activities over the phone or in person through onsite coverage at hospitals, provider offices, City agencies, community business partners and Community Based Organizations (CBO’s).Complete and review all applications prior to submitting to NYSOH marketplace.Assist members...

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Vendor Credentialing Specialist (Temp)

Req ID: R021743  |  Remote

Routine TasksDaily review of incoming credentialing cases across PITS and UPE, identify delegated providers and update case notes as needed, import new non-delegated initial providers into CVO, and assign cases to designated credentialing staff. Provide feedback and communicate issues to CVO as...

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Field Entitlement Enrollment Team Lead

NY  |  Req ID: R021665  |  Hybrid

Duties & Responsibilities:Supervises Retention Advocates- This includes observing staff in the field (travel within NYC, Westchester and Nassau counties) and conducting customer phone audits to ensure all activities are completed in accordance with Company protocols and State...

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Senior Field Entitlement Enrollment Specialist

NY  |  Req ID: R021693  |  Hybrid

Duties & Responsibilities:Interprets product, procedural and regulatory information, and assists with the development of training curricula to provide field staff with available services.Administers new hire training and refresher training to the Senior Retention Advocates and Retention...

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Medicare Sales Support Associate

NY  |  Req ID: R021713  |  Remote

Responsible for coordinating events, presentations and enrollment opportunities, as directed by the Sales Managers, in order to execute, plan, and coordinate resources so that they can ensure a successful event.Live Healthfirst’s mission, our members are our North Star and our mission is guided...

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Account Specialist

NY  |  Req ID: R021703  |  On-site

Duties and Responsibilities: Identifies potential members and designs a plan to educate potential members regarding the health benefits and care that is tailored for the member as well as provide information regarding the particular plan’s features and benefits. For existing members, will review...

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Project Planning & Operations Specialist

NY  |  Req ID: R021520  |  Hybrid

Duties/ResponsibilitiesFacilitates cross-functional collaboration through regular retail site visits and daily coordination with multiple stakeholders including Sales, Member Services, EDS, Brand/Marketing, Facilities, Fleet, Technology/IT, Compliance to support existing retail sites.Identifies...

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Grievance Specialist

FL  |  Req ID: R021865  |  Remote

Key Responsibilities:Independently manage a caseload of grievances through the full case lifecycle, from written acknowledgement to investigation, resolution, and written member resolution letters.Conduct detailed research by collaborating cross-functionally with internal departments (e.g.,...

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Project Manager- Provider Operations

NY  |  Req ID: R021720  |  Hybrid

Job DescriptionDuties and Responsibilities:Organizes and leads the project team through the entire project life cycle.Works with internal and external teams as applicable to ensure business needs are clearly understood and the technology implemented meets the needs and expectations of the...

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Manager, Appeals and Grievances

NY  |  Req ID: R021619  |  Hybrid

Work ScheduleThis position requires three days per week in office (Tues/Wed/Thurs) at either: 100 Church St. New York, NY. or 1101 Greenwood Blvd. Lake Mary, FL.Duties and Responsibilities:Ensure management team is accurately monitoring performance through daily meetings, coaching, feedback,...

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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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Change Manager

NY  |  Req ID: R019440  |  Hybrid

Duties & Responsibilities:Manages assigned initiatives, including workplan development, stakeholder management, change management, implementation, success measurement, and communication of project status to business stakeholders.Partners with IT and Delivery teams in the delivery of technical...

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