Healthfirst

Retention Advocate Team Lead

NY  |  Req ID: R018970  |  Hybrid

Duties & Responsibilities:Supervise Retention Advocates- This includes observing staff in the field (travel within NYC, Westchester and Nassau counties) and conducting customer phone audits to ensure all activities are completed in accordance with Company protocols and State...

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MLTC Referral and Enrollment Specialist (Bilingual- Bengali)

NY  |  Req ID: R019079  |  On-site

Manage a broad base of agencies, services, and professionals as referral sources. Responsible for scouting new providers and referral sources, while meeting departmental guidelines. Must meet monthly referral goal per department guidelines. This includes:Obtaining weekly designated Licensed Home...

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Broker Center Agent

NY  |  Req ID: R019178  |  Remote

-Provide high quality on-line and telephone assistance to all Customers - Members, Small Groups and Brokers; and Providers as required (e.g., Claim audits) -Provide high quality handling of customer inquiries, via mail, e-mail and on-line inquiries and chat sessions. -Resolve inquiries and issues...

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Strategic Account Management Associate

NY  |  Req ID: R019277  |  Hybrid

Responsibilities:· Leading a team of Hospital Specialists in a Matrix environment· Document and recommend changes to existent processes as part of workflow redesign to align to new Strategic Account Management structure· Coordinate account activity and workflow, including but not limited to the...

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Sr QA Analyst (Remote)

FL  |  Req ID: R017525  |  Remote

• Ensure all strategic projects and operational projects meet the highest quality possible by following industry recognized QA methodologies and best practices. The candidate must have experience in structured testing methodology, with a proven ability to breakdown business...

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MuleSoft Application Developer

NY  |  Req ID: R018631  |  Remote

Duties & Responsibilities:Apply API-led connectivity concepts to business initiatives to help program achieve their goalConfiguring APIs, API portals, proxy endpoints and API analytics based on technical specifications with MuleSoft API managerDesigning and developing enterprise services...

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Principal Cloud Database Engineer - Remote

FL  |  Req ID: R017983  |  Remote

Duties and Responsibilities:Database Design and Implementation: Design, develop, and implement cloud-based database solutions in collaboration with development teams. Create database schemas, tables, and indexes to support efficient data storage and retrieval.Cloud Database Administration:...

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ServiceNow - Principal Engineer

FL  |  Req ID: R018193  |  Remote

Chief technical designer for ServiceNow code and architecture, responsible for overall ServiceNow code qualityProvide day-to-day administrative ServiceNow support, including advanced support via troubleshooting, implementing bug fixes and root cause analysisMonitor health, usage, and overall...

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Senior Manager, Migrations (ETL)

NY  |  Req ID: R019039  |  Hybrid

Job Description:Lead, mentor, and manage a team of technical professionals working on migration initiatives supporting technologies SAS, Informatica, Tableau, Alteryx, Redshift, etc.Provide guidance on technical issues, career development; foster a collaborative and high-performance work...

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Director, Provider Management Solution Lead

NY  |  Req ID: R019154  |  Hybrid

Duties & Responsibilities:Assists in the development of strategic plans to ensure modern and efficient claims processing across the entire lifecycle with a focus on a unified, streamlined experience for both providers and operations staffWorks closely with technology and business leadership...

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Sr Technical Data Product Owner/ Sr Manager

NY  |  Req ID: R018991  |  Remote

Responsibilities: This role is an integral member of the project delivery team responsible for maximizing the ROI. He/she will work with the business to understand future state needs to inform and direct the project work.  He/she is empowered by the organization to represent and make decisions...

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Care Manager - Episodic UM/CM-1

Req ID: R019144  |  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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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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Appeals and Grievances Clinical Specialist - RN or LPN, 100% Remote

NY  |  Req ID: R019259  |  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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Care Manager - Long Term Care 100% Remote

NY  |  Req ID: R019227  |  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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Field Service Agent (Bilingual Spanish for Bronx)

Req ID: R019186  |  On-site

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, claims process, escalations, and productsManage face-to-face encounters by interacting with customers to provide...

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Care Manager - High Risk Maternity

NY  |  Req ID: R019083  |  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...

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Remote Bilingual Spanish Pediatric Care Manager

NY  |  Req ID: R017944  |  Remote

Duties/Responsibilities:Adhere 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 the...

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Clinical Pharmacist - Hybrid

NY  |  Req ID: R018335  |  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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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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