Healthfirst

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

Home Office, NY  |  Req ID: R019259  |  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 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  |  Hybrid  |  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 (Brooklyn)

Field Office, NY  |  Req ID: R019132  |  Hybrid  |  Clinical Services

The schedule is Mon-Fri 9AM-5:30PM and requires travel within Brooklyn. We are looking for candidates who reside in Brooklyn.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 (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  |  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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Care Manager - Complex Care

Req ID: R018756  |  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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Care Manager - High Risk Maternity

Home Office, NY  |  Req ID: R019083  |  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 - 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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Certified Peer Support Specialist (Hybrid) NYC Area

New York, NY  |  Req ID: R018895  |  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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Clinical Coding Auditor

Home Office, NY  |  Req ID: R019194  |  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 Pharmacist - Hybrid

New York, NY  |  Req ID: R018335  |  Remote  |  Clinical Services

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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Clinical Support - Care Coordinator - 100% Remote

Home Office, NY  |  Req ID: R018504  |  Remote  |  Clinical Services

Duties and Responsibilities: Receive incoming calls from members regarding benefit questions/issues, care coordination, program inquiries, connecting to their care manager, and screening assessments to identify risk factors requiring medical interventionContemporaneously and accurately documents...

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Field Care Coordinator - Mandarin & Cantonese Fluency (Travel NYC Area)

Field Office, NY  |  Req ID: R019150  |  Hybrid  |  Clinical Services

The schedule is Monday-Friday 9AM-5:30PM. This position requires travel to our members' homes in the various boroughs, Westchester and Long Island. You will only be scheduled for 1-2 zip codes in a concentrated area on the same day to make it more efficient. Full fluency in English, Mandarin...

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Field Care Coordinator, Fluent in Russian and Ukranian (travel NYC area)

Field Office, NY  |  Req ID: R019138  |  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. This position requires full fluency in English, Russian and...

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Field-Based Pediatric Assessment Nurse - Bronx

Field Office, NY  |  Req ID: R018936  |  On-site  |  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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