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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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A&G Non Clinical Specialist

Home Office, NY Req ID: R018852 Remote Clinical Services
**This position is RemoteDuties and ResponsibilitiesResponsible for case development and resolution of non-clinical cases, such as: certain types of claim denials, member complaints, and member and provider appeals.  The end-to-end process requires the Specialist to independently:Research...
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Behavioral Health Project Manger

New York, NY Req ID: R018414 Hybrid Clinical Services
Regulatory Compliance:Ensure adherence to regulatory initiatives and requirements, actively participating in relevant meetings as assigned.Documentation Management:Maintain Job Aides and Policies & Procedures, updating them in response to changes or new regulatory mandates, products, or...
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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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Clinical Disenrollment Specialist

Home Office, NY Req ID: R018884 Remote Clinical Services
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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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 Pharmacist, Pharmacy Benefits

Home Office, NY Req ID: R018481 Remote Clinical Services
Duties & Responsibilities:Works collaboratively to oversee clinical operations of assigned pharmacy benefitsProvides clinical pharmacy support for the pharmacy benefit —including but not limited to: override requests, external appeals, program design, program implementation/oversight, content...
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Clinical Quality Manager

New York, NY Req ID: R018431 Hybrid Clinical Services
 Job DescriptionInteracts with hospitals, providers, and members to improve quality of care, monitor progress, and recommend changesReviews billing codes, medical records, and claims submission processes to ensure accuracyAttends and facilitates any initiative meetings (studies, partnerships)...
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Field Care Coordinator - American Sign Language Fluency & other language fluency besides English

Field Office, NY Req ID: R018706 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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