Healthfirst (New York) Jobs in United States

Care Coordinators support members navigating their health care system, providing excellent customer service. · Certified Medical Assistant (CMA) or Certified Nursing Assistant (CNA) or Registered Medical Assistant (RMA) or previous relevant medical training or work experience · H ...

The Paralegal will provide assistance & general support to the Legal department in its interaction with the business. · Providing support to in-house legal counsel or the organization's attorney to address legal issues · Reviewing and logging Fair Hearing notices; compiles and co ...

The Senior Analyst, Internal Audit and Controls will be responsible for the identification and assessment of Internal Controls over Financial Reporting (ICFR). You are a fit if you have experience with Sarbanes Oxley (SOX), Internal Control Frameworks and//or Internal Audit, disp ...

The Operations Strategic Data Analyst embraces complex, disparate data sets and leading technologies to design data models, craft scoring methodologies and develop algorithms that inform the leaders of our business on our performance. · Operate with intellectual curiosity and cri ...

The Senior Technical Analyst, Care Management is responsible for promoting and enabling a data-driven culture within Healthfirst Operations. They understand the health insurance industry and their department to identify opportunities for technology and analytics to improve effici ...

The Vice President, Claims and Provider Operations leads the delivery of provider data management, original claims processing, and claims rework functions. · Provides strategic guidance, direction, and management to lead and support a workforce in the areas of provider lifecycle ...

The Manager Assessment Nurse ensures prospective and active members are appropriately screened by Assessment Nurse team to meet enrollment and clinical eligibility requirements. · Leads and manages daily Reassessment Nurse operations such as overseeing scheduling and staffing, pr ...

The Sr. Enterprise Data Architect is responsible for aligning the future state enterprise information architecture with the corporate strategy. · Plays a leadership role in the definition and execution of the Information Management roadmap. · Supports Data Architecture roadmap by ...

The Case Manager coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, and case management as assigned. The Case Manager is also responsible for efficient utilization of health services and optimal health outcomes fo ...

Pega Tech Lead//Manager Opportunity available at Healthfirst. Designs, develops, and maintains complex applications using Pega solutions that adhere to platform best practices. · Designs, develops, and maintains complex applications using Pega solutions that adhere to platform be ...

The Case Manager coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, and case management as assigned. · Pre-certification – performing risk-identification, preadmission, concurrent, and retrospective reviews to eva ...

The Product Owner will help create and deliver a best-in-class business systems and operational processes. · Define & communicate the overall vision, objectives and goals of the business. · Enable delivery of Product Backlog by presenting backlog to team. · Contribute to the matu ...

The Program Coordinator supports Healthfirst initiatives and regulatory requirements related to Member Rewards and Incentives, HEDIS Quality Improvement, Medicare Stars and Member Satisfaction. · Verifies reward requests based on required preventive services · Conducts member and ...

The Social Worker is responsible for assessing members' goals, cultural preferences, strengths, informal supports and social determinants of health needs. · LMSW or LCSW · Fluent in Spanish · PHI electronic shared network database and archival system experience · Thorough knowled ...

The Care Manager plans and manages behavioral and/or physical care with members and works collaboratively with them, their supports, providers, and health care team members. · Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benef ...

The Case Manager coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, and case management as assigned. · RN, LPN, LMSW, LMHC, LMFT, LCSW, PT, OT, and/or ST license · Master's degree in a related discipline · Provide ...

The Hospital Specialist is the point person responsible for ensuring maximization of operational efficiency between Healthfirst and our network hospitals. · Managing day to day operational issues and concerns from hospital partners including but not limited to roster maintenance ...

The Grievance Specialist is a member of the Appeals & Grievances (A&G) team at Healthfirst and is responsible for managing and resolving member or authorized representative–initiated grievances and complaints across Healthfirst's product lines. · Independently manage a caseload o ...

The Field Service Agent acts as an in-person liaison between Healthfirst and its customers, receiving and addressing member & provider inquiries, de-escalating and resolving complaints, educating clients, and engaging in member retention activities. · Provide high-quality custome ...

Design and development of integration services and components on multiple projects in an agile environment. · Participate in the design and delivery of integration projects · Contribute to key phases of the development lifecycle · Designs and develops high quality APIs/Integratio ...