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Hybrid Coding Educator

NY Req ID: R019210 Hybrid
Trains clinical providers on coding guidelines, ensuring compliance around clinical documentation, coding guidelines. Using AMA Coding guidelines, CMS coding regulations, ICD10 coding rules and coding industry standards.Preparation and creation of PowerPoint presentations for department...
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Support Specialist

NY Req ID: R018367 Remote
Duties and Responsibilities: Conduct outreaches for newly enrolled members to review current and approved services, durable medical equipment (DME) and additional requestsReview intake documents for pre-approved services and escalate discrepancies as neededComplete Welcome Onboarding and Consumer...
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Support Specialist

NY Req ID: R018358 Remote
Duties and Responsibilities: Conduct outreaches for newly enrolled members to review current and approved services, durable medical equipment (DME) and additional requestsReview intake documents for pre-approved services and escalate discrepancies as neededComplete Welcome Onboarding and...
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Care Manager - 100% Remote

NY Req ID: R018426 Remote
Duties and Responsibilities:The care manager will be responsible for dual eligibility plan.Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.Conducts assessments to identify barriers and opportunities for intervention.Develops care plans...
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Manager of Vendor Performance

NY Req ID: R018646 Hybrid
Duties & Responsibilities:Ensure successful onboarding and offboarding of Healthfirst delegated vendors.Continuously review and update vendor performance goals and expectationsMonitor and manage delivery of vendor services through a full-service engagement model.Leverage delegated vendor...
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Clinical Quality Manager

NY Req ID: R018887 Hybrid
Job Description- 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)...
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Remote Clinical Pharmacist

NY Req ID: R018836 Remote
Duties & Responsibilities:Support initiatives to resolve gaps in care through direct provider and member outreach, collaboration with provider engagement, and leveraging our pharmacy network capabilitiesEnsure that all recommendations are consistent with the latest guidelines or otherwise...
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Care Manager - Complex Care

Req ID: R018756 Remote
Duties and Responsibilities:Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.Conducts assessments to identify barriers and opportunities for intervention.Develops care plans that align with the physician’s treatment plans and recommends...
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Manager, Enrollment & Billing

NY Req ID: R018961 Hybrid
•Implements and communicates departmental standards•Manages employee performance and the quality of the team's work•Monitors productivity reports and department report card•Manages and develops Team Leads to be effective leaders•Works with Team Leads to establish and implement departmental goals,...
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Remote Manager Clinical A&G

NY Req ID: R019019 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 HF’s...
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Senior Manager, Medical Policy

NY Req ID: R019098 Hybrid
Duties/Responsibilities:Develops, reviews, and updates medical policies and clinical guidelines to ensure they are evidence-based and aligned with best practicesCollaborates with clinical experts and stakeholders to gather input and ensure policies reflect the latest advancements in medical...
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