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Keeping New Yorkers Healthy

At Healthfirst, we offer comprehensive care services to our members in the community. We aim to keep our members safe, healthy, and provide attentive care. We have many opportunities available in different clinical specialties.

Where Compassion Meets Community

Assessment Nurses are pivotal to our work at Healthfirst, connecting members to the care that they need. See what a day in the life of our nurses really looks like in the communities we serve, why they love what they do, and what it means to be part of Healthfirst.

Open Positions in Nursing and Clinical

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Clinical Quality Manager

New York, NY Req ID: R021902 Hybrid Clinical Services
Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changesReviews billing codes, medical records, and claims submission process to ensure accuracyAttends and facilitates any initiative meetings (studies, partnerships) that involve targeted...
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Clinical Quality Manager

New York, NY Req ID: R021694 Hybrid Clinical Services
Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changesReviews billing codes, medical records, and claims submission process to ensure accuracyAttends and facilitates any initiative meetings (studies, partnerships) that involve targeted...
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Director of Medical Reviews

Req ID: R021698 Hybrid Clinical Services
Duties & Responsibilities:The Medical Director 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 Director will render determinations in the...
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Director Utilization Management

New York, NY Req ID: R021231 Hybrid Clinical Services
Duties/Responsibilities:Provide strategic direction and leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requestsDevelop strong operational and leadership capabilities within the organization through performance...
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Field Assessment Registered Nurse, Bronx, NY - $10,000 Sign-On Bonus (Spanish)

Field Office, NY Req ID: R021617 Hybrid Clinical Services
Duties and Responsibilities: ·       Conducts home assessments (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...
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Hybrid Assessment Registered Nurse, Bronx, NY- $7,500 Sign-On Bonus (Spanish)

New York, NY Req ID: R021856 Hybrid Clinical Services
Duties and Responsibilities: ·       Conducts home assessments (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...
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Manager, Appeals and Grievances

New York, NY Req ID: R021619 Hybrid Clinical Services
Work ScheduleThis position requires three days per week in office (Tues/Wed/Thurs) at either: 100 Church St. New York, NY. or 1101 Greenwood Blvd. Lake Mary, FL.Duties and Responsibilities:Ensure management team is accurately monitoring performance through daily meetings, coaching, feedback,...
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Medical Peer Reviewer

Req ID: R021699 Remote Clinical Services
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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Peer Support Specialist

Field Office, NY Req ID: R021592 Hybrid Clinical Services
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...
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Peer Support Specialist

New York, NY Req ID: R021779 Hybrid Clinical Services
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...
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Senior Manager Clinical Eligibility

New York, NY Req ID: R021813 Hybrid Clinical Services
Duties & Responsibilities:  Participates in all aspects of personnel management to ensure appropriate staffing, orientation, support, discipline, and timely performance appraisals.Meets regularly with direct reports to review goals, trends, and performance measures and to facilitate...
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Senior Regulatory Specialist

Home Office, NY Req ID: R021884 Remote Clinical Services
Duties & Responsibilities:Monitor incoming regulations including those received from Centers for Medicare and Medicaid Services (CMS), State Department of Health (DOH), Office of Medicaid Inspector General (OMIG) and other channels.Share regulatory guidance with Pharmacy department and...
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