Healthfirst

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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Director Configuration, Benefit Administration

NY  |  Req ID: R021941  |  Hybrid

This position requires three days per week in office (Tues/Wed/Thurs) at 100 Church Street, NYC Duties & Responsibilities:Develop and implement comprehensive operational strategies aimed at improving efficiency, productivity, and qualityLead initiatives to identify inefficiencies in current...

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Senior Reconciliation & Recovery Analyst

FL  |  Req ID: R021986  |  Hybrid

Duties & Responsibilities: Operate with intellectual curiosity and critically assess existing processes and procedures to identify opportunities for improvementDevelop complex analyses requiring the integration of multiple data sources, evaluation of data quality, and standardization of data...

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Process Manager Enrollment and Billing

FL  |  Req ID: R021896  |  Hybrid

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:Ensuring successful execution of assigned business processesForecasting, tracking, trending and reporting out operational...

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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 Pharmacist, MTM

NY  |  Req ID: R021967  |  Remote

Duties & Responsibilities:Support initiatives to resolve gaps in care through direct provider and member outreach, collaboration with provider engagement, and leveraging our pharmacy network capabilitiesEnsure that all recommendations are consistent with the latest guidelines or otherwise...

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Appeals and Grievances Clinical Specialist

NY  |  Req ID: R021907  |  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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Manager Clinical Appeals and Grievances

NY  |  Req ID: R021587  |  Remote

Duties and Responsibilities:Manages a team of specialists, with responsibility for goal and productivity management, coaching and counseling, performance management and other leadership responsibilities as assignedProvides oversight in case research and provides advice as neededUnderstands HF’s...

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Hybrid Assessment Registered Nurse, Bronx, NY- $7,500 Sign-On Bonus (Spanish)

NY  |  Req ID: R021990  |  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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Team Lead, Appeals and Grievances, Non Clinical Specialist

NY  |  Req ID: R021988  |  Hybrid

Duties/Responsibilities: Lead and support a team responsible for investigating and resolving non-clinical appeals and/or grievancesManage team performance, including productivity, quality, timeliness, case progression, and adherence to regulatory requirementsProvide coaching, feedback, and...

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Grievances Specialist

FL  |  Req ID: R022016  |  Remote

Key Responsibilities:Independently manage a caseload of grievances through the full case lifecycle, from written acknowledgement to investigation, resolution, and written member resolution letters.Conduct detailed research by collaborating cross-functionally with internal departments (e.g.,...

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Product Owner, Corporate Business Technology

NY  |  Req ID: R021951  |  Hybrid

Define & communicate the overall vision, objectives and goals of the business. Articulate the minimum viable product needs. Create, refine, socialize and prioritize the Product backlog.Enable delivery of Product Backlog by presenting backlog to team; creating, owning and refining well-formed...

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Care Coordinator

NY  |  Req ID: R021958  |  Remote

Duties and Responsibilities: Receive incoming calls from members regarding benefit questions/issues, care coordination, program inquiries, connecting to their care manager, and screening assessments to identify risk factors requiring medical interventionContemporaneously and accurately documents...

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Peer Support Specialist

NY  |  Req ID: R021592  |  Hybrid

Duties/Responsibilities:Manages designated caseload of members who could benefit from Peer Support services, care coordination, and health navigationSchedules and conducts multiple field-based visits per day (clustered by geographic areas)Completes assessments and questionnaires to identify...

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Peer Support Specialist

NY  |  Req ID: R021779  |  Hybrid

Duties/Responsibilities:Manages designated caseload of members who could benefit from Peer Support services, care coordination, and health navigationSchedules and conducts multiple field-based visits per day (clustered by geographic areas)Completes assessments and questionnaires to identify...

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Staff Accountant | Hybrid NY

NY  |  Req ID: R022033  |  Hybrid

Hybrid Work Schedule:This role is considered hybrid which consists of working at our office located at 100 Church Street, NYC 3 days per week (Tuesday/Wednesday/Thursday). Duties/Responsibilities:Ensure all accounts are reconciled monthly and work with other stakeholders within Finance such as...

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Senior Manager, HR Technology & Integration | Hybrid NY

NY  |  Req ID: R021981  |  On-site

Key Responsibilities1. Integration Ownership & Architecture (PRIMARY)Define and own end-to-end HR system integration architecture across:Workdayvendor platforms (benefits, LOA, learning, etc.)case management systems (HRA, ServiceNow)Design and document data flows, integration patterns, and...

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Investigator, Special Investigations Unit | Remote

NY  |  Req ID: R021846  |  Remote

This position is 100% remote.Scope of ResponsibilitiesConduct investigations of Providers, Representatives, Employees, Members, contracted groups and othersCompile data into written reports: collect, utilize & interpret data obtained from a variety of reports and other sources, thereby...

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Senior HR Process & Service Design Manager | Hybrid NY

NY  |  Req ID: R021807  |  On-site

Key Responsibilities1. Process Architecture & Design (Primary Accountability)Own end-to-end design of HR service processes across key workflows:onboarding and preboardingleave of absence (LOA)employee relations (ER) workflowsHR case managementworkforce and employment lifecycle processesDefine...

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