Healthfirst

Appeals and Grievances Clinical Specialist

NY  |  Req ID: R022221  |  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...

Apply Learn more >

Share

• Email
• Facebook

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

NY  |  Req ID: R022139  |  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...

Apply Learn more >

Share

• Email
• Facebook

Clinical Quality Manager

NY  |  Req ID: R022232  |  Hybrid

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

Apply Learn more >

Share

• Email
• Facebook

Field Assessment Registered Nurse, Bronx, NY - $10,000 Sign-On Bonus (Spanish)

NY  |  Req ID: R022117  |  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...

Apply Learn more >

Share

• Email
• Facebook

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...

Apply Learn more >

Share

• Email
• Facebook

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...

Apply Learn more >

Share

• Email
• Facebook

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...

Apply Learn more >

Share

• Email
• Facebook

Peer Support Specialist

NY  |  Req ID: R021126  |  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...

Apply Learn more >

Share

• Email
• Facebook

HR Shared Services Senior Specialist | Hybrid NY

NY  |  Req ID: R022302  |  Hybrid

Key ResponsibilitiesEmployee Lifecycle ManagementManage end-to-end employee lifecycle processes, including new hire pre-boarding, onboarding and offboarding transactions.Provide support and guidance to employees, managers, and HR Business Partners across Tiers.Resolve complex employee inquiries...

Apply Learn more >

Share

• Email
• Facebook

Configuration and Quality Audit Analyst | Hybrid NY

NY  |  Req ID: R022168  |  On-site

Duties and ResponsibilitiesPerform routine, targeted, and risk-based audits of provider pricing configuration and claims across multiple lines of business, products, and provider types.Interpret provider contract reimbursement language and translate terms into expected system outcomes for claims...

Apply Learn more >

Share

• Email
• Facebook

Configuration and Quality Audit Manager | Hybrid NY

NY  |  Req ID: R022169  |  On-site

Duties and ResponsibilitiesBuild, lead, and mature the claim configuration quality audit function, including audit planning, methodology, governance, quality standards, reporting, and remediation oversight.Develop and maintain a risk-based audit plan that prioritizes claim configuration and...

Apply Learn more >

Share

• Email
• Facebook

Instructional Designer | Hybrid NY or FL

NY  |  Req ID: R022192  |  Hybrid

This is a hybrid role which consists of reporting to our NY or FL office on Tuesdays, Wednesdays, Thursdays (100 Church Street, New York, NY 10007 | 1101 Greenwood Blvd, Lake Mary, FL 32746)​Duties & Responsibilities:Partner with senior instructional designer or other learning leader to...

Apply Learn more >

Share

• Email
• Facebook

Facilities Support Specialist | Onsite Lake Mary, FL

FL  |  Req ID: R022158  |  On-site

On-site work schedule consists of reporting to our Lake Mary, FL office 5 days per week.Scope of Responsibilities:Inspect facilities and review inspection reports to determine repairs or improvements required to both facility and security related systems.Support, help develop, implement, and...

Apply Learn more >

Share

• Email
• Facebook

Senior Manager, Benefits | Hybrid NY

NY  |  Req ID: R022149  |  Hybrid

Duties and Responsibilities:With the direction from the Benefits Director, you will assist in the development and execute a comprehensive benefits strategy that aligns with the organization's goals, culture, and budget which includes but not limited to; 401K, medical, dental, vision, life...

Apply Learn more >

Share

• Email
• Facebook

Senior Analyst, Total Cost of Care - Hybrid NY

NY  |  Req ID: R021527  |  Hybrid

This role will be onsite at 100 Church Street, New York, NY 10007 on Tuesdays, Wednesdays, and Thursdays.Scope of Responsibilities:Develop actionable analytic tools to help monitor medical cost and utilization trends, provide concise insight into the root cause drivers, and work with the team to...

Apply Learn more >

Share

• Email
• Facebook

Senior Manager, HR Technology & Integration | Hybrid NY

NY  |  Req ID: R021981  |  Hybrid

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...

Apply Learn more >

Share

• Email
• Facebook

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...

Apply Learn more >

Share

• Email
• Facebook

Senior Manager, HRBP - IT | Hybrid NY

NY  |  Req ID: R021863  |  Hybrid

Scope of Responsibilities:Proactively supports the delivery of all HR initiatives and processes.Builds a strong business relationship with the internal clients and serves as a key advisor and confidante, enabling strong management and leadership for the Department.Facilitates the design and...

Apply Learn more >

Share

• Email
• Facebook

Director, Workforce Analytics and Strategy - Hybrid NY

NY  |  Req ID: R021579  |  Hybrid

Scope of ResponsibilitiesPartner with the HR Leadership Team, Leadership Development Team and HR Business Partners to inform and deliver upon Healthfirst’s talent strategyUsing data, identify solutions which will address Healthfirst’s strategic objectivesOversee the development of compelling...

Apply Learn more >

Share

• Email
• Facebook

Healthcare Analyst - Hybrid NY

NY  |  Req ID: R021709  |  Hybrid

Work ScheduleThis is a hybrid position which consists of reporting to our 100 Church Street, NYC office on Tuesdays, Wednesdays & Thursdays.Duties & Responsibilities:Analyze the financial performance of all Healthfirst products, identify favorable and unfavorable trends, develop...

Apply Learn more >

Share

• Email
• Facebook