Healthfirst

Appeals and Grievances Clinical Specialist - RN or LPN - 100% Remote

Home Office, NY  |  Req ID: R019565  |  Remote  |  Clinical Services

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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Bilingual Albanian Field Care Coordinator (travel NYC area)

Field Office, NY  |  Req ID: R019146  |  Hybrid  |  Clinical Services

The schedule is Mon-Fri 9AM-5:30PM and requires travel to the boroughs, Westchester and Long Island. Please note you will only be scheduled for the in-home appointments in 1-2 zip codes close to each other on the same day.Duties/Responsibilities:Schedules and conducts multiple home visits per day...

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Bilingual Pediatric Care Manager

Home Office, NY  |  Req ID: R019621  |  Remote  |  Clinical Services

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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Bilingual Punjabi Field Care Coordinator (travel NYC area)

Field Office, NY  |  Req ID: R019128  |  Hybrid  |  Clinical Services

The schedule is Mon-Fri 9AM-5:30PM and requires travel to the boroughs, Westchester and Long Island. Please note you will only be scheduled for the in-home appointments in 1-2 zip codes close to each other on the same day.Duties/Responsibilities:Schedules and conducts multiple home visits per day...

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Bilingual Spanish Field Care Coordinator (Bronx)

Field Office, NY  |  Req ID: R019139  |  On-site  |  Clinical Services

The schedule is Mon-Fri 9AM-5:30PM and requires travel within the Bronx. We are looking for candidates who reside in the Bronx. Duties/Responsibilities:Schedules and conducts multiple home visits per day (clustered in small geographic areas)Supports the Healthfirst clinical team members,...

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Bilingual Spanish Field Care Coordinator (Manhattan)

Field Office, NY  |  Req ID: R019137  |  Hybrid  |  Clinical Services

The schedule is Mon-Fri 9AM-5:30PM and requires travel within Manhattan. We are looking for candidates who reside in Manhattan.Duties/Responsibilities:Schedules and conducts multiple home visits per day (clustered in small geographic areas)Supports the Healthfirst clinical team members, including...

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Bilingual Spanish Field Care Coordinator (Queens)

Field Office, NY  |  Req ID: R019208  |  Hybrid  |  Clinical Services

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...

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Bilingual Spanish Field Care Coordinator (Staten Island)

Field Office, NY  |  Req ID: R019245  |  On-site  |  Clinical Services

*The schedule is Monday-Friday 9AM-5:30PM and requires travel around Staten Island for in-home appointments with our members. We are looking for candidates who live in Staten Island.Duties/Responsibilities:Schedules and conducts multiple home visits per day (clustered in small geographic...

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Bilingual Spanish Field Care Coordinator (travel NYC area)

Field Office, NY  |  Req ID: R019131  |  On-site  |  Clinical Services

The schedule is Mon-Fri 9AM-5:30PM and requires travel to the boroughs, Westchester and Long Island. Please note you will only be scheduled for the in-home appointments in 1-2 zip codes close to each other on the same day.Duties/Responsibilities:Schedules and conducts multiple home visits per day...

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Bilingual Spanish Field Care Coordinator (Westchester)

Field Office, NY  |  Req ID: R019397  |  On-site  |  Clinical Services

The schedule is Monday-Friday 9AM-5:30PM and requires travel within Westchester. We are looking for candidates who live in the Westchester area and are fully fluent in Spanish to meet with our members in their homes.Duties/Responsibilities:Schedules and conducts multiple home visits per day...

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Care Manager

Home Office, NY  |  Req ID: R019754  |  Remote  |  Clinical Services

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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Care Manager - 100% Remote

Home Office, NY  |  Req ID: R019493  |  Remote  |  Clinical Services

Duties and Responsibilities:The care manager will be responsible for dual eligibility plan.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...

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Care Manager - Complex Care

Home Office, NY  |  Req ID: R019504  |  Remote  |  Clinical Services

**This position is 100% RemoteDuties 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...

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Care Manager - Interdisciplinary Team - Hybrid - $3,000 Sign On Bonus

New York, NY  |  Req ID: R019036  |  Hybrid  |  Clinical Services

Duties and Responsibilities:Provides telephonic (and occasional onsite) care management to support the member’s care needs to promote positive health outcomes.Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.Attends Interdisciplinary Team...

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Care Manager - Long Term Care 100% Remote

Home Office, NY  |  Req ID: R019227  |  Remote  |  Clinical Services

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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Clinical Operational Rightfax Expert - Remote

Req ID: R019653  |  Remote  |  Clinical Services

Responsibilities: Electronic logging of documentation and subsequent notification to downstream entities including Utilization Management (UM), Care Management (CM) or other teams.  Ensure that the input information is correct and complete, including member/provider information, medical records,...

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Clinical Pharmacist, Pharmacy Engagement - Hybrid NY

New York, NY  |  Req ID: R019647  |  Hybrid  |  Clinical Services

Duties & Responsibilities:Establishes positive, collaborative, and consultative relationships with partner hospitals, community network providers, population health teams and community pharmacies.  Provides ongoing strategic recommendations to decrease pharmacy costs and improve formulary...

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Clinical Pharmacist, Provider Engagement - Hybrid NY

New York, NY  |  Req ID: R019601  |  Hybrid  |  Clinical Services

Duties & Responsibilities:Establishes positive, collaborative, and consultative relationships with partner hospitals, community network providers, population health teams and community pharmacies.  Provides ongoing strategic recommendations to decrease pharmacy costs and improve formulary...

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Complex Care Manager - High Risk Diabetes

Home Office, NY  |  Req ID: R019725  |  Remote  |  Clinical Services

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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Episodic Support Coordinator UM/CM

Req ID: R019363  |  Remote  |  Clinical Services

Duties and Responsibilities: Provides excellent quality customer service to our members and/or providers relating to authorization updates, questions/issues such as coordinating care, DME outreach, scheduling appointments, and screen assessments to identify risk factors which need closer...

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