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Remote Clinical UM Pharmacist

NY Req ID: R018811 Remote
Duties & Responsibilities: Monitor and review prior authorization requests for medicationsCalculate appropriate billable units based on dosing, indication, weight, BMI and other clinical considerationsDevelop clinical criteria and medical policies for the review of medicationsEnsure all...
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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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Mail Operations Clerk

FL Req ID: R018882 On-site
Duties and ResponsibilitiesMeet departmental goals regarding productivity, quality, timeliness and accuracy to meet SLAs.Complete work per policies and job aids.Provide a high level of customer service.Perform quality checks on letters to make sure the letters are accurate in terms of address...
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Clinical Disenrollment Specialist

NY Req ID: R018884 Remote
Duties/Responsibilities:·        Applies clinical and critical thinking skills in evaluating the content of disenrollment requests·        Communicates with the clinical teams regarding safety concerns and regulatory requirements on an ongoing basis·        Proficiently uses systems and...
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Sr Operations Coding Analyst

NY Req ID: R018910 Hybrid
** This position is RemoteDuties & Responsibilities: Conducts independent assessments of current claims edits to ensure comprehensive and defensible claims editing is in place across all Healthfirst product linesParticipate in special projects and advanced Claims Coding activitiesProactively...
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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...
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Sr Healthcare Analyst

NY Req ID: R017672 Hybrid
Job Description:Produce and manage annual hospital performance review packets.Monitor costs and revenue trends for hospitals and identify route cause of developing trends.Understand and analyze impacts of new program changes such as new benefits or new populations.Prepare monthly analysis for...
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Privacy Manager | Hybrid NYC

NY Req ID: R018421 Hybrid
This is a hybrid work schedule consists of reporting to our NY office from Tuesday through Thursday. We are located at 100 Church Street, NYC 10007.Duties and Responsibilities:Conducts and promotes Privacy training and awareness to the workforce.Responsible for Privacy training content &...
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AVP, Vendor Contracting

NY Req ID: R018408 Hybrid
Lead negotiations and participate in RFP and other business development opportunities and supports due diligence and evaluation process for new potential vendors as needed.Execute an effective vendor management governance and oversight frameworkProvide senior leadership-level oversight and...
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Actuarial Analyst

NY Req ID: R018828 Hybrid
Duties and Responsibilities:Handle premiums, claims, enrollment, and administrative expense data for reports to government and regulatory entities (such as CMS, NYSID, NYDOH, etc.) as well as routine internal reportsPerform risk score, pricing and other data analytics for Medicare productsAssist...
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