Healthfirst

Project Manager- Clinical Transformation

FL  |  Req ID: R021984  |  On-site

Duties and Responsibilities:Organize and lead project teams through the full project life cycle, from initiation through implementation and stabilizationDevelop, maintain, and manage project plans, timelines, milestones, meeting documentation, status reports, decision logs, issue trackers, and...

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Senior Project Manager of Clinical Transformation

NY  |  Req ID: R021985  |  On-site

Duties and Responsibilities:Lead end-to-end implementation of AI-enabled clinical platforms supporting UM, Care Management, prior authorization, population health, or related clinical operationsManage large-scale transformation initiatives involving workflow redesign, system integration, data...

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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 NY Licensed M.D. or D.O. Part Time Remote

NY  |  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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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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Long Term Care Care Coordinator - Float Team

NY  |  Req ID: R022290  |  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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Manager Clinical Quality Data Validation and Governance

NY  |  Req ID: R022216  |  Hybrid

Essential Duties and Responsibilities:Strategy, Governance & ComplianceLeads governance and oversight of HEDIS clinical supplemental data sources, clinical data validation, medical record review, and supplemental data processes.Establishes and maintains data quality standards, validation...

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Vendor Partner Specialist - Clinical Support Team - Spanish Fluency

NY  |  Req ID: R022128  |  Remote

Duties and responsibilitiesAnalyze, manage and delegate daily workflow to and from external vendors to ensure proper execution of tasks and meeting of SLAs are accurate.Analyze and ensure vendor accuracy by reviewing and consolidating work product to identify trends and gapsCommunicate regularly...

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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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Information Owner

TX  |  Req ID: R022276  |  Remote

Has decision rights and accountability for data collection, data movement, data quality, data definitions, data retention, and data use by both internal and external data consumersDirects consumers of data on utilization best practices; i.e data stewards, analyst, data architects, and...

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Sr QA Analyst, Claims

NC  |  Req ID: R022260  |  Remote

Duties & Responsibilities:Owns the overall roadmap of automation solutions in collaboration with development and QA team.Develops reusable automation components for Pega based and other applicationsMentors automation engineers in team to optimize automation outcomesDevelops utilities to...

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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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Field Service Agent - Bilingual Spanish - Manhattan

NY  |  Req ID: R022308  |  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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Field Service Agent - Queens - Bilingual Spanish

NY  |  Req ID: R022150  |  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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Field Service Agent - Queens - Bilingual Mandarin/Cantonese

NY  |  Req ID: R022070  |  On-site

**Preferred Bilingual Mandarin and/or Cantonese Job DescriptionDuties/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...

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CCO Service Agent - 100% Remote

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...

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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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Senior Provider Network Contractor – Out-of-Network Provider Negotiations

NY  |  Req ID: R022225  |  Hybrid

Strategic Out-of-Network Provider EngagementIdentify and prioritize high-cost, high-utilization, and strategically critical out-of-network providers and facilities based on claims data, network gaps, and regulatory network adequacy requirements.Develop and execute targeted outreach strategies to...

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Driver (CDL Class A, B or C )

NY  |  Req ID: R022067  |  On-site

Checks the interior and exterior of the vehicle for cosmetic and operational concerns.Performs minor maintenance tasks on the vehicle when necessary, included but not limited to daily vehicle inspections and the inspection of all engine fluids.Maintains confidentiality by keeping all potential...

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Ancillary Network Account Manager

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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