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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

2026 Technology Early Career Development Program – Quality Assurance/App Support

NY  |  Req ID: R021430  |  Hybrid

This position requires three days per week in office (Tues/Wed/Thurs) at 100 Church Street, NYC For this role we are looking for candidates with project, internship or work experience SQL, Java, C.  Candidates should have fundamental knowledge or skills in unit testing and databases....

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

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...

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: R021231  |  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

Senior Regulatory Specialist

NY  |  Req ID: R021884  |  Remote

Duties & Responsibilities:Monitor incoming regulations including those received from Centers for Medicare and Medicaid Services (CMS), State Department of Health (DOH), Office of Medicaid Inspector General (OMIG) and other channels.Share regulatory guidance with Pharmacy department and...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

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...

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

Vice President, Contact Center Operations

NY  |  Req ID: R021784  |  Hybrid

This is a hybrid position which consists of reporting to our 100 Church Street, NYC office 3 days per week (Tuesdays, Wednesdays & Thursdays).Duties/Responsibilities:Establish and execute the long-term strategic roadmap for the Contact Center of the Future, leveraging AI-driven automation,...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

CCO Service Agent

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn

CCO Service Agent – Language Requirement

NY  |  Req ID: R021945  |  Remote

Healthfirst 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 service to our members...

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, 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...

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

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

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...

Apply Learn more >

Share

• Email
• Facebook
• LinkedIn