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Ancillary Services Network Account Manager I

NY Req ID: R021330 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...

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Hospital Specialist

NY Req ID: R021755 Hybrid

Responsibilities:Managing day to day operational issues and concerns from hospital partners including but not limited to roster maintenance and claim issue root cause analysisManaging education/training regarding company-wide initiatives including but not limited to new product implementation,...

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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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Field Entitlement Enrollment Specialist

NY Req ID: R021664 On-site

Duties & Responsibilities:Contacts member or primary caregiver by phone or letter to arrange a telephonic or in person interview to assess Medicaid/Medicare/Medicare Savings Program eligibility. Ensures all calls and conversations are conducted in accordance with approved Healthfirst...

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Sr Healthcare Analyst, LTCP Risk Score Accuracy - Hybrid NY

NY Req ID: R021645 Hybrid

Location:This is a hybrid role which consists of working at 100 Church Street, New York, NY 10007 on Tuesdays, Wednesdays, and Thursdays.Summary:The Sr Healthcare Analyst, LTCP Risk Score Accuracy is responsible for managing risk score expectations, communicating project and financial results and...

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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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Facilities Support Specialist - Lake Mary, FL - Onsite

FL Req ID: R021099 On-site

On-site work schedule consists of reporting to our Lake Mary, FL office 5 days per week.Scope of Responsibilities:Inspect facilities and review inspection reports to determine repairs or improvements required to both facility and security related systems.Support, help develop, implement, and...

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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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Business Analyst

FL Req ID: R021570 Hybrid

Duties & Responsibilities: Defining and eliciting business requirements for assigned project or company initiatives Communicate departmentally and interdepartmentally to recommend and request new concepts and/or modifications to existing workflow, system set up, tools and designs.Identify...

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IT Product Intern – 2026 Summer Internship

NY Req ID: R021502 Hybrid

Duties & Responsibilities:• Operate with intellectual curiosity and critically assess existing processes and procedures to identify opportunities for improvement• Hold oneself accountable for the accuracy, completeness, quality, and relevance of deliverables in order to own responsibility for...

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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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Clinical UM Pharmacist

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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Appeals and Grievances Clinical Specialist

NY Req ID: R021706 Remote

**This position has two schedules available: M-F 8am-5:30pm (8x5) or Wed-Sat 7am or 7:30am - 5pm or 5:30pmDuties and Responsibilities:Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification,...

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Redefine your search:

Filter jobs by

Ancillary Services Network Account Manager I

Hospital Specialist

State Programs Member Engagement Specialist (Facilitated Enrollment)

Vendor Credentialing Specialist (Temp)

Field Entitlement Enrollment Team Lead

Senior Field Entitlement Enrollment Specialist

Medicare Sales Support Associate

Field Entitlement Enrollment Specialist

Sr Healthcare Analyst, LTCP Risk Score Accuracy - Hybrid NY

Project Planning & Operations Specialist

Facilities Support Specialist - Lake Mary, FL - Onsite

Project Manager- Provider Operations

Manager, Appeals and Grievances

2026 Technology Early Career Development Program - Data/Cloud Engineer

Business Analyst

IT Product Intern – 2026 Summer Internship

Change Manager

Clinical UM Pharmacist

Appeals and Grievances Clinical Specialist

Appeals and Grievances Clinical Specialist

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