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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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,...

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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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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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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...

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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 – 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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Healthcare Operations Analyst (Provider Data)

FL  |  Req ID: R021485  |  Remote

Key ResponsibilitiesOperational OptimizationAnalyze provider data workflows to identify inefficiencies, rework, and process gaps.Recommend and implement scalable solutions to improve turnaround times and reduce manual effort.Support initiatives focused on operational excellence and continuous...

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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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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...

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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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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...

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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...

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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...

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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...

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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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