Healthfirst

Medicare Outside Sales Representative

NY  |  Req ID: R021453  |  Hybrid

Duties & Responsibilities:Drive membership growth by acquiring new members while also meeting aggressive retention targets.Work directly with community-based organizations, providers, sales locations, and other sources to develop self-generated referral channels resulting in increased...

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Support Specialist

NY  |  Req ID: R021882  |  Remote

Duties and Responsibilities: Conduct outreaches for newly enrolled members to review current and approved services, durable medical equipment (DME) and additional requestsReview intake documents for pre-approved services and escalate discrepancies as neededComplete Welcome Onboarding and Consumer...

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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, 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...

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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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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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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...

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CCO Service Agent - 100% Remote

NY  |  Req ID: R021943  |  Remote

Duties and Responsibilities Provides excellent quality customer service to our members and/or providers relating to all aspects of member/provider questions and issues such as eligibility, benefits, claims process, escalations, and product questions, etc. May include but is not limited to...

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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...

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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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Director, Delivery System Engagement (DSE) Network Optimization Program Management

NY  |  Req ID: R021837  |  Hybrid

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, 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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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...

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Provider Network Account Manager

NY  |  Req ID: R021908  |  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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Social Media Manager

NY  |  Req ID: R021704  |  On-site

Duties and ResponsibilitiesCreative Development & Content ExecutionDevelop and lead creative concepts and content series that bring Healthfirst’s mission, programs, and community impact to life on social media.Write and refine copy tailored to social channels, ensuring alignment with brand...

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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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