Healthfirst

Care Manager, RN - Restricted Recipient Program

NY  |  Req ID: R021102  |  Remote

Duties//Responsibilities of the Restricted Recipient Program:Oversees the care management of members in the NYS RRP who require tightly managed access to medical services due to their historic misuse//abuse of Medicaid program resources.Conducts medical reviews of member usage patterns analyzing...

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Bilingual Pediatric Care Manager

NY  |  Req ID: R020904  |  Remote

**This position is 100% RemoteDuties/Responsibilities:The Pediatric Care Manager plans and manages pediatric medical and/or behavioral care with members and their beneficiaries across the continuum of care. The Care Manager is assigned to a specific product line such as PHSP, Child Health Plus,...

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RN Care Manager, Bilingual Spanish - $3,000 Sign-On Bonus

NY  |  Req ID: R021073  |  Hybrid

Duties and Responsibilities:Provides telephonic (and occasional onsite) care management to support the member’s care needs to promote positive health outcomes.Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.Attends Interdisciplinary Team...

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Sales Support Associate

NY  |  Req ID: R021039  |  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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Entitlement Advocate

NY  |  Req ID: R020994  |  Hybrid

Duties and ResponsibilitiesSHP Renewal Line: (Inbound//Outbound)Handle 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...

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Community Relations Specialist-Bronx/Manhattan

NY  |  Req ID: R020677  |  On-site

The candidate must successfully achieve the following:· Contribute to the development and implementation of strategies to build and nurture relationships with community partners, organizations, and stakeholders· Create, maintain and foster partnerships to drive positive impact and company growth·...

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Community Relations Specialist - Bilingual Mandarin/Cantonese

NY  |  Req ID: R020683  |  On-site

RESPONSIBILITIES The candidate must successfully achieve the following: Contribute to the development and implementation of strategies to build and nurture relationships with community partners, organizations, and stakeholdersCreate, maintain and foster the partnerships to drive positive impact...

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Manager, Medicare Commissions

NY  |  Req ID: R020905  |  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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FQHC Provider Network Account Manager

NY  |  Req ID: R020991  |  Hybrid

Job Description· 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...

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Sales Support Associate

NY  |  Req ID: R020744  |  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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Hospital Claims Relationship Specialist

NY  |  Req ID: R020883  |  Hybrid

Responsibilities:Managing day to day operational issues and concerns from hospital partners including but not limited to roster maintenance and claim issue root cause analysisManaging education/training regarding company-wide initiatives including but not limited to new product implementation,...

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Bilingual Call Center Rep (Relationship Coordinator)- Mandarin and/or Cantonese

NY  |  Req ID: R021018  |  Remote

Duties and ResponsibilitiesHandling inbound and outbound calls to and from customers to address their needs while adhering to internal Service Levels standards.Creates and/or follow ups for up to 90 days on Long-Term Care (LTC) Leads and Opportunities entered in Salesforce.Create and/or follow...

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

NY  |  Req ID: R021042  |  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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Field Assessment RN, Queens, NY - $10,000 Sign-On Bonus (Chinese fluency)

NY  |  Req ID: R021072  |  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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Field Assessment RN, Bronx, NY - $10,000 Sign-On Bonus

NY  |  Req ID: R020984  |  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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Hybrid Assessment RN, Queens, NY - $7,500 Sign-On Bonus (Mandarin or Cantonese)

NY  |  Req ID: R020974  |  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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Field Assessment RN, Bronx, NY - $10,000 Sign-On Bonus (Spanish)

NY  |  Req ID: R021040  |  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 Operations - Business Analyst - 2025 Summer Internship

NY  |  Req ID: R020290  |  Hybrid

Job Description In the Clinical Performance Optimization team, you will work with process improvements, project go-lives, and reporting/analytics. This is a critical team that will provide insight across various programs and lines of businesses across the company.     Duties &...

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Sr. Enterprise Data Architect

NY  |  Req ID: R021006  |  Remote

Duties and Responsibilities:Plays a leadership role in the definition and execution of the Information Management roadmap. Supports Data Architecture roadmap by managing architectural runway for enterprise data model, enterprise data store/warehouse, information management, and advanced data...

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Manager Enrollment and Billing

NY  |  Req ID: R020160  |  Hybrid

Duties and Responsibilities:Oversee the enrollment process, ensuring timely and accurate processing of new and modified enrollments, renewals, and terminations.Collaborate with internal teams (e.g., sales, customer service, compliance) to ensure seamless management of members.Monitor ,report, and...

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