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UM Case Manager

NY Req ID: R020374 Remote
**This position is 100% RemoteDuties/Responsibilities:Provides case management services for assigned member caseloads which includes:Pre-certification – performing risk-identification, preadmission, concurrent, and retrospective reviews to evaluate the appropriateness and medical necessity of...
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Pharmacy Financial Analyst - Hybrid NYC

NY Req ID: R019903 Remote
Duties & Responsibilities:Provides cost and trend surveillance for all lines of business.  Leads the analysis of all designated categories to understand the drivers of cost and utilization increases/decreases, by designated category and provider compared to designated budget.Collaborates with...
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Associate Medicare Retention Programs

NY Req ID: R019542 Hybrid
Duties & Responsibilities:Support Medicare Retention Strategy Manager in overseeing and measuring a broad range of existing Medicare customer retention initiativesAnalyze, measure, and evaluate the outcomes of new member welcome eventsCollaborate with stakeholder teams, including sales, to...
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Medicare Outside Sales Representative

NY Req ID: R020265 On-site
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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Bilingual Sr Retention Advocate

NY Req ID: R020377 Hybrid
Duties & Responsibilities:Contact 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 are in accordance to approved Healthfirst scriptsHas full and complete access to...
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Manager, Medicare Commissions

NY Req ID: R020254 Hybrid
Duties & Responsibilities:Has oversight of the entire broker appointment process to ensure proper completion of contracts and marketing agreements.Responsible for reviews of credentialing paperwork, confirmation of active licenses, and assignment of specific coding to be assigned to all new...
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Legal Intern

NY Req ID: R019290 Hybrid
Responsibilities:This role will focus primarily on provider and vendor contract drafting, corporate governance, evidence collection for litigation and pre-litigation disputes, as well as administrative law hearing preparation and appearances.  The legal intern will assist and work directly with...
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Sr. Claims Coding Analyst

NY Req ID: R020231 Hybrid
Duties & Responsibilities: Analyze and interpret health insurance benefits and coverage details to apply appropriate medical codes.Accurately assign procedure (CPT, HCPCS) and diagnosis codes (ICD-10) represent patient services, treatments, copays, and coinsuranceVerify coding accuracy to...
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QA Auditor, Appeals and Grievances

NY Req ID: R020413 Remote
Conduct quality audits of A&G items including grievances, pre-service appeals, and post service appeals utilizing appropriate sources of information; including eligibility, claims, authorizations, service forms, faxes, and any additional information required to complete the request. Analyze...
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CCO Service Agent

NY Req ID: R020415 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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