Healthfirst

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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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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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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Account Specialist

NY  |  Req ID: R021703  |  On-site

Duties and Responsibilities: Identifies potential members and designs a plan to educate potential members regarding the health benefits and care that is tailored for the member as well as provide information regarding the particular plan’s features and benefits. For existing members, will review...

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

FL  |  Req ID: R021431  |  Hybrid

This position requires three days per week in office (Tues/Wed/Thurs) at 1101 Greenwood, Lake Mary, FL.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....

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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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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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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...

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Clinical Quality Manager

NY  |  Req ID: R021902  |  Hybrid

Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changesReviews billing codes, medical records, and claims submission process to ensure accuracyAttends and facilitates any initiative meetings (studies, partnerships) that involve targeted...

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

NY  |  Req ID: R021856  |  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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Clinical Quality Manager

NY  |  Req ID: R021694  |  Hybrid

Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changesReviews billing codes, medical records, and claims submission process to ensure accuracyAttends and facilitates any initiative meetings (studies, partnerships) that involve targeted...

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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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Internal Audit Analyst (Hybrid-NY)

NY  |  Req ID: R021921  |  On-site

Duties & Responsibilities:· Participate in the identification, rationalization, and evaluation of internal controls. Such activities may include (but not be limited to):· Maintain and update internal control / Model Audit Rule documentation, including Flow Charts, Process Narratives, Job...

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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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