Healthfirst

Senior Project Manager

NY  |  Req ID: R021985  |  Hybrid

Duties and ResponsibilitiesLead end-to-end delivery of complex, enterprise-wide initiatives focused on operational efficiency, program transformation, technology enablement, and performance improvementTranslate strategic objectives into actionable project plans with clear scope, timelines,...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

Director, Utilization Management

NY  |  Req ID: R021977  |  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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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

NY  |  Req ID: R021989  |  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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

AVP, Community Engagement

NY  |  Req ID: R021917

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

CCO Service Agent – Bilingual - 100% Remote

NY  |  Req ID: R021945  |  Remote

**This position is 100% remoteHealthfirst has multiple openings for CCO Agents for different languages to support our members.  We are seeking agents that have Russian or Mandarin/Cantonese or Spanish skills that are bilingual.Duties and Responsibilities Provides excellent quality customer...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

Ancillary Services Network Account Manager I

NY  |  Req ID: R021927  |  Hybrid

Manage a network of Ancillary Providers for all lines of Healthfirst's business (such as Medicaid, CHP, Medicare, and Commercial). Monitor and audit contracted ancillary providers to ensure that accurate demographic, payment and fee schedules are loaded into the HF Provider System...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

Broker Sales Support Associate

NY  |  Req ID: R021940  |  Hybrid

Description and RequirementsThe Sales Support Associate is responsible for positioning Healthfirst as a socially responsible health partner. S/he will develop and coordinate plans of action that promote company-wide enrollment through promotions, events, sponsorships and collaboration with...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

Senior Network Account Manager

NY  |  Req ID: R021405  |  Hybrid

· Advance Healthfirst through superior customer service focused leadership in an assigned territory and team, which will help to optimize provider satisfaction· Educate and train network representatives in key business principles around profitability, network adequacy, quality, etc.· Promote...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

Marketing Analyst

NY  |  Req ID: R022051  |  On-site

Duties/Responsibilities:Collect and analyze campaign performance data to create actionable insights that can be leveraged by marketing managers to improve the performance of our marketing campaigns.Prepare and automate campaign performance reporting including reports showing the ROI of marketing...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

Medicare Inside Sales Representative

NY  |  Req ID: R022024  |  Hybrid

Duties & Responsibilities: Stakeholder Engagement & Brand Representation Promotes hyper-local value propositions, acting as the Healthfirst ambassador in every phone call and enhancing Healthfirst brand and value propositionsDelivers effective sales presentations over the phone to...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn