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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.

Caring for Our Members

Cyndi helps members open pathways to essential services and community entitlements for high-risk behavioral health children and their families. She collaborates with case managers to ensure that members are empowered and well-prepared to lead healthy lives and stay safe in their communities. Interested in joining our Nursing and Clinical Operations team? Check out our available positions listed below.

Open Positions in Nursing and Clinical

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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 - 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 Auditor: Appeals and Grievances

Home Office, NY Req ID: R019368 Remote Clinical Services
Duties and Responsibilities:Maintains tracking tools to log audit results including areas of non-compliance and informing what areas of improvement are needed for discussion with management and/or at departmental team meetingsAssists with evaluating and analyzing aggregate quality performance...
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Clinical Claims Auditor

Home Office, NY Req ID: R019315 Remote Clinical Services
Duties/Responsibilities:Examines provider claims and service authorizations for completeness, accuracy, and medical necessity and proposes resolutions per internal and regulatory processes.Communicates to relevant teams and providers any claims/ authorization inaccuracies found along with...
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Clinical Pharmacist, Pharmacy Engagement

New York, NY Req ID: R019448 Hybrid Clinical Services
Build relationships with community pharmacies and support them in various performance metrics including adherence and patient satisfaction.Establish positive, collaborative, and consultative relationships with network providers including community pharmacies, hospital and community providers and...
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Clinical Quality Manager

New York, NY Req ID: R018887 Hybrid Clinical Services
Job Description- Interacts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changes- Reviews billing codes, medical records, and claims submission process to ensure accuracy- Attends and facilitates any initiative meetings (studies, partnerships)...
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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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