Skip to content

Redefine your search:

Filter jobs by

Part Time Assessment RN, Bronx, NY

NY Req ID: R018029 Hybrid
Duties and Responsibilities:  ·       Conducts in-person (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...

Remote Care Manager, Long Term Care

NY Req ID: R018122 Remote
Duties/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...

RN/SW Care Manager - 100% Remote

NY Req ID: R017354 Remote
Duties/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...

Bilingual Spanish Field Care Coordinator (Queens)

NY Req ID: R017620 Hybrid
Duties/Responsibilities:Schedules and conducts multiple home visits per day (clustered in small geographic areas)Supports the Healthfirst clinical team members, including UAS nurses and Care Managers, by facilitating cross-cultural communications and interpreting the employee-to-member and...

Bilingual Spanish Field Care Coordinator (Brooklyn)

NY Req ID: R017632 Hybrid
Duties/Responsibilities:Schedules and conducts multiple home visits per day (clustered in small geographic areas)Supports the Healthfirst clinical team members, including UAS nurses and Care Managers, by facilitating cross-cultural communications and interpreting the employee-to-member and...

Sr Clinical Policy Analyst

NY Req ID: R018172 Remote
Duties/Responsibilities:Support the Medical Policy and Clinical Utilization Management (UM) Governance Committee Chairs, committee members, and related workgroups by organizing all meeting materials (e.g. meeting minutes, presentations, etc.), tracking follow-up activities, and...

Certified Peer Support Specialist (Hybrid)

NY Req ID: R018161 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...

Operations Strategic Data Analyst

FL Req ID: R018202 Remote
This position is Hybrid FL or Hybrid NY Duties & Responsibilities: Operate with intellectual curiosity and critically assess existing processes and procedures to identify opportunities for improvementDevelop complex analyses requiring the integration of multiple data sources, evaluation of...

Weekend A&G Clinical Specialist - 100% Remote

NY Req ID: R018252 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...

Weekend A&G Clinical Coordinator - 100% Remote

NY Req ID: R018221 Remote
Prepare cases for the clinical team by gathering documentation, loading evidence, and making calls to members and providers.Perform administrative activities including but not limited to generating and printing determination and authorization notification letters.Complete all associated data...

Project Manager - Operations

NY Req ID: R018130 Hybrid
** This position Hybrid NY or Hybrid FL Duties and Responsibilities:Organizes and leads the project team through the entire project life cycle.Works with internal and external teams as applicable to ensure business needs are clearly understood and the technology implemented meets the needs...

A&G Weekend Inventory Manager

NY Req ID: R018244 Remote
Duties & Responsibilities:Prepare and plan the weekend staff’s assignments and volume to ensure complianceTriage and assign expedited appeals while helping standardize and optimize how Appeals and Grievances are routedManage inventory to ensure regulatory compliance for appeals processed...

Clinical Correspondence/Writer-1

NY Req ID: R018266 Remote
Duties and Responsibilities:·       Conduct daily reviews of member and provider correspondence while reviewing clinical system (TruCare) events to ensure compliance with all State and Federal regulations.·       Meet established time frames for completion of assigned correspondence.·      ...

Clinical Correspondence Writer/Editor-4

NY Req ID: R018265 Remote
Duties and Responsibilities:Conduct daily reviews of member and provider correspondence while reviewing clinical system (TruCare) events to ensure compliance with all State and Federal regulations.Meet established time frames for completion of assigned correspondence.Identify deficiencies and...
41-60 of 100 results