Healthfirst

Clinical UM Pharmacist

NY  |  Req ID: R021764  |  Remote

Duties & Responsibilities: Monitor and review prior authorization requests for medicationsCalculate appropriate billable units based on dosing, indication, weight, BMI and other clinical considerationsDevelop clinical criteria and medical policies for the review of medicationsEnsure all...

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Appeals and Grievances Clinical Specialist

NY  |  Req ID: R021707  |  Remote

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, Reduction, Termination, and Suspension of services. The end to end process requires the Specialist...

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Mgr Clinical Appeals and Grievances

NY  |  Req ID: R021587  |  Remote

Duties and Responsibilities:Manages a team of specialists, with responsibility for goal and productivity management, coaching and counseling, performance management and other leadership responsibilities as assignedProvides oversight in case research and provides advice as neededUnderstands HF’s...

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Hybrid Assessment Registered Nurse, Bronx, NY- $7,500 Sign-On Bonus (Spanish)

NY  |  Req ID: R021856  |  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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Clinical Quality Manager

NY  |  Req ID: R021694  |  Hybrid

Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changesReviews billing codes, medical records, and claims submission process to ensure accuracyAttends and facilitates any initiative meetings (studies, partnerships) that involve targeted...

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Technical Quality Assurance Manager

NY  |  Req ID: R021765  |  Remote

Duties & Responsibilities:Aligns Testing Support Services under the Quality Assurance Team for strategic planning as it pertains to organization standards.Builds the testing process and policies along with defining technical solutions and tools to support the testing framework.Ensures that...

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Technical Product Owner, Extracts, Information Management

FL  |  Req ID: R021624  |  Hybrid

Key Responsibilitieso    Lead delivery execution for assigned data capabilities, ensuring alignment to priorities, timelines, and quality expectations set by product and platform leadership.o    Manage and mentor a multidisciplinary team (onshore/nearshore/offshore as applicable), fostering...

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Peer Support Specialist

NY  |  Req ID: R021779  |  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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Care Manager - Maternity

NY  |  Req ID: R021749  |  Remote

- Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.- Conducts assessments to identify barriers and opportunities for intervention.- Develops care plans that align with the physician’s treatment plans and recommends interventions that...

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Behavioral Health Care Manager, HARP (Fluent English/Spanish)

NY  |  Req ID: R021719  |  Remote

Duties/Responsibilities:Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.Conducts assessments to identify barriers and opportunities for intervention.Develops care plans that align with the physician’s treatment plans and recommends...

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Director, Benefits | Hybrid NY

NY  |  Req ID: R021814  |  On-site

Scope of Responsibilities:Strategic Direction Lead the design and delivery of benefits programs, ensuring alignment with business goals, market practices, and employee needsDirect the strategy and administration of employee benefits, recognition, and retirement programsEnsure strategic alignment...

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Director, Workforce Analytics and Strategy - Hybrid NY

NY  |  Req ID: R021579  |  Hybrid

Scope of ResponsibilitiesPartner with the HR Leadership Team, Leadership Development Team and HR Business Partners to inform and deliver upon Healthfirst’s talent strategyUsing data, identify solutions which will address Healthfirst’s strategic objectivesOversee the development of compelling...

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Healthcare Analyst - Hybrid NY

NY  |  Req ID: R021709  |  Hybrid

Work ScheduleThis is a hybrid position which consists of reporting to our 100 Church Street, NYC office on Tuesdays, Wednesdays & Thursdays.Duties & Responsibilities:Analyze the financial performance of all Healthfirst products, identify favorable and unfavorable trends, develop...

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Senior Manager, HR Shared Services - Hybrid NY

NY  |  Req ID: R021577  |  Hybrid

Work ScheduleThis role is hybrid which requires you to report to 100 Church Street, New York, NY three days per week (Tuesday/Wednesday/Thursday).Scope of ResponsibilitiesStrategic Transformation & Modernization MandateStabilize and elevate a high-volume HR service environment.Transform HR...

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Director, HR Technology Programs - Hybrid NY

NY  |  Req ID: R021580  |  On-site

Work ScheduleThis role is required to be at 100 Church Street, New York, NY three days per week (Tuesday/Wednesday/Thursday).Scope of Responsibilities:Technology Transformation & OperationsIn partnership with Program Management, IT, and HR Centers of Excellence (COEs), lead HR technology...

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Manager, Total Cost of Care

NY  |  Req ID: R021526  |  Hybrid

This role requires working onsite at 100 Church Street, New York, NY 10007 on Tuesdays, Wednesdays and Thursdays.Scope of Responsibilities:Monitor medical cost and utilization trends, provide concise actionable insight into the root cause drivers, and develop potential remediation opportunities....

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Senior Analyst, Total Cost of Care - Hybrid NY

NY  |  Req ID: R021527  |  Hybrid

This role will be onsite at 100 Church Street, New York, NY 10007 on Tuesdays, Wednesdays, and Thursdays.Scope of Responsibilities:Develop actionable analytic tools to help monitor medical cost and utilization trends, provide concise insight into the root cause drivers, and work with the team to...

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