Healthfirst

Remote Clinical Pharmacy Technician

NY  |  Req ID: R019622  |  Remote

Duties & Responsibilities:Performs review of medication lists to understand and eliminate barriers to medication therapy while serving as the member's Pharmacy Navigator to achieve proper medication adherence, minimize gaps in therapy, and prevent medication related adverse...

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Bilingual Pediatric Care Manager - Spanish or Mandarin/Cantonese

NY  |  Req ID: R019695  |  Remote

***This position is 100% RemoteAdhere to standards of care for children including but not limited to developmentally disabled, medically fragile and foster care populationsDevelops a member centric plan of care through collaboration with member (as age appropriate), family, appointed guardian and...

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Senior Dental Analyst, Pharmacy Department

NY  |  Req ID: R019694  |  Hybrid

Duties & Responsibilities:Conducts market research and understands members’ needs to ensure our current dental benefit remain competitive and sustainable.Designs interactive dashboards that provide an at-a-glance view of key performance indicators (KPIs), member feedback based on appeals and...

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Care Manager, LTC Mandarin or Cantonese or Fujianese Fluency

NY  |  Req ID: R019837  |  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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Remote Bilingual Lead Clinical Pharmacist

NY  |  Req ID: R019876  |  Remote

Duties & Responsibilities:Supports initiatives to resolve gaps in care through direct provider and member outreach, collaboration with provider engagement, and leveraging our pharmacy network capabilitiesEnsures that all recommendations are consistent with the latest guidelines or otherwise...

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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...

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Appeals and Grievances Clinical Specialist – RN, LPN, or Dental Hygienist - 100% Remote

NY  |  Req ID: R020008  |  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...

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Senior Pharmacy Financial Analyst

NY  |  Req ID: R020146  |  Remote

Duties & Responsibilities:Pharmacy and Dental costs and trend surveillance for all lines of business.  Leads the analysis of all therapeutic and dental categories to understand the drivers of cost and utilization increases/decreases for pharmacy and benefit drug spend.Works collaboratively to...

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Administrative Assistant, Legal - Hybrid NY

NY  |  Req ID: R019929  |  Hybrid

Scope of Responsibilities:Schedules and organizes complex activities such as internal and external meetings, travel arrangements, and conferences, sends out invites, agendas and meeting minutes as required.Manages incoming and outgoing mail, including drafting written responses or replies by...

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Legal Intern - 2025 Summer Internship

NY  |  Req ID: R019807  |  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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Medicaid & LTC Finance Intern – 2025 Summer Internship

NY  |  Req ID: R019857  |  Hybrid

Duties & Responsibilities: Develop an understanding of Healthfirst’s unique business model, with a focus on financial data and trends related to Medicaid and LTC products Attend meetings with cross-functional teams to learn how the Finance department supports operational...

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Provider Risk Analytics Intern (Finance) - 2025 Summer Internship Program

NY  |  Req ID: R019853  |  Hybrid

Duties & Responsibilities: Develop an understanding of the Healthfirst overall business and risk model, with a focus on how to support provider organizations to improve financial performance and how value-based care can drive improved outcomes Attend internal and external provider meetings to...

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Learning Delivery Specialist

NY  |  Req ID: R019571  |  Hybrid

Duties & ResponsibilitiesFacilitate and deliver learning events to support the enterprise inclusive of all business units. Serve as subject matter expert (SME) in the design and development of learning content partnering with business leaders and the instructional design group. Assist with...

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Manager, Actuarial Services - Medicaid

NY  |  Req ID: R019123  |  Hybrid

Scope of Responsibilities:Monitor experience for Healthfirst's Medicaid lines of business.Analyze and interpret impacts of premium rate changes and other regulatory changes, including support of premium rate advocacy efforts.Perform analysis of changing populations, benefits, and other trends...

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Learning Delivery Specialist

NY  |  Req ID: R017782  |  Hybrid

Duties & ResponsibilitiesFacilitate and deliver learning events to support the enterprise inclusive of all business units. Serve as subject matter expert (SME) in the design and development of learning content partnering with business leaders and the instructional design group. Assist with...

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Sr Healthcare Analyst - Medical Economics

NY  |  Req ID: R018888  |  Hybrid

Duties & Responsibilities:Value new medical cost initiatives, applying financial modeling expertise and using independent judgement to determine the best methods and approaches to calculate accurate estimates of program savings.Provide data driven analysis to Finance, Claims, Medical...

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Manager, Actuarial Services - Medicare | Hybrid NY

NY  |  Req ID: R018830  |  Hybrid

Duties and Responsibilities:Monitor experience under Healthfirst's Medicare line of business.Provide support for annual Medicare bids for all Healthfirst's Medicare products.Assist in other actuarial functions such as in incurred but not reported (IBNR) analysis and other ad hoc...

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Senior Data Analyst, Medical Economics and Medical Cost, Hybrid NY

NY  |  Req ID: R019033  |  Hybrid

Duties and ResponsibilitiesValue new medical cost initiatives, applying financial modeling expertise and using independent judgement to determine the best methods and approaches to calculate accurate estimates of program savings.Provide data driven analysis to Finance, Claims, Medical Management,...

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Manager, Actuarial Services

NY  |  Req ID: R018918  |  Hybrid

The Manager Actuarial Services – Trend is responsible for managing actuarial analysis, modeling, and deliverables related to Medical Trend across all Healthfirst lines of business, as outlined in the scope of responsibilities.Scope of Responsibilities:Build and maintain models for analyzing...

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Billing Operations Analyst - Hybrid NY

NY  |  Req ID: R019195  |  Hybrid

Duties & Responsibilities: Generate and review the State billing files for all Healthfirst products. Ensure billed records are accurate based on approved contracted rates from Department of Health and correct any errors from exception reports. Ensure State...

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