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Medical Peer Reviewer

NY Req ID: R021188 Remote
Duties//Responsibilities:The Medical Peer Reviewer will assess//review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations.The Medical Peer Reviewer will render determinations in the...
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Clinical Navigation Team Mgr Care Mgmt

NY Req ID: R020999 Remote
Duties//Responsibilities:·        Develops and monitors team goals; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; routinely evaluates staff’s clinical skills and technical comprehension; and ensures an atmosphere of open communication, teamwork,...
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Manager Assessment Nurse

NY Req ID: R021008 Hybrid
Duties and Responsibilities: Leads and manages daily Reassessment Nurse operations such as overseeing scheduling and staffing, providing clinical consultations, and ensuring departmental productivity goals are met in regards to quality, timeliness, accuracy, and consistency.Coordinates and...
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Field Service Agent (Mandarin/Cantonese)

NY Req ID: R020920 On-site
Must be able to commute across multiple counties and boroughs: including Manhattan, Brooklyn and Queens boroughs. Duties//Responsibilities:Provide high-quality customer service to providers and members across all LOBs with a variety of questions and issues on topics such as eligibility, benefits,...
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AVP, Corporate Compliance

NY Req ID: R020940 Hybrid
Hybrid Work ScheduleThis position requires three days per week in the office at 100 Church Street, NYC (Tues/Wed/Thurs).Duties and ResponsibilitiesLeadership point of contact and subject matter expert on all compliance related matters; provides guidance to leadership and the Compliance team...
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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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Product Strategy Analyst

NY Req ID: R021146 Hybrid
Duties & Responsibilities:· Work collaboratively with finance analysis, sales, population health, operations, marketing, and other departments as necessary to support strategic plans to achieve market growth, quality and financial objectives· Compile information from multiple sources to...
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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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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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