Jobs at Healthfirst

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Displaying results 1 - 15 of 99

Clinical Service Auditor

Healthfirst - Telecommuter

Responsibilities: Examines Service Authorizations for completeness and accuracy. Communicates to Care Management teams any inaccuracies found along with recommended solutions. Reviews large sets of claims data and recommends changes in the claims submission and authorization processes. Communicates with providers regarding any claim or authorization is...

Application Deadline: None

Application Lifecycle Management (ALM) Administrator

Healthfirst - New York, NY

Responsibilities: Managing, improving and driving Quality Center usage, best practices and enhancements for Information Services Quality Assurance (QA) organization. Uses analytical skills, advanced knowledge of VBScripting,Structured Query Language (SQL) and Excel Macro to perform complex workflow analysis as well as capture, analyze and communicate metrics fo...

Application Deadline: None

Social Worker Complete Care

Healthfirst - Telecommuter

Responsibilities: Uses all available resources to assess members' psychosocial health status and social work needs; this includes making field home visits as needed in order to complete a psychosocial assessment for all new members within the first 30 days of enrollment. Determines member and family needs to develop a comprehensive care plan for each member based on counsel...

Application Deadline: None

Clinical Outreach Specialist

Healthfirst - New York, NY

Responsibilities: Provides clinical support and guidance to approximately 8-10 staff members (outreach coordinators). Responds to questions raised during member outreach calls and troubleshoots/intervenes as needed. Conducts telephonic outreach to certain populations of members with significant health issues and/or co-morbidities to help improve access to care and the overa...

Application Deadline: None

Member Services Representative - Bilingual Cantonese/Mandarin

Healthfirst - New York, NY

Responsibilities: Interacting by phone with customers to provide information in response to inquiries, concerns and questions about their coverage and products Healthfirst offers. Transferring calls from members to proper lines of business such as, Enrollment, Provider Services, Claims, Medical Management, etc. Following-up on customer inquiries and complaints th...

Application Deadline: None

Clinical Manager, Care Management SHP

Healthfirst - New York, NY

Responsibilities: Supervises, directs, and evaluates approximately 10-12 staff members per virtual CMT (Social Worker and RN). Conducts prospective new hire interviews, conflict resolution, and performance evaluations for each CMT. Provides instruction(s), continued system(s) training, and supervision to CMT direct reports while ensuring all CMT staff are contributing to the Members C...

Application Deadline: None

Assistant Director, Behavioral Health Quality Improvement

Healthfirst - New York, NY

Responsibilities: Develops and maintains requirement solutions for planned behavioral health programs including Health and Recovery Plan (HARP), to ensure compliance with all regulatory requirements. Responsible for all studies and performance improvement projects related to behavioral health subjects, including all of those required for HARP implementation and maintenance....

Application Deadline: None

Member Services Representative

Healthfirst - New York, NY

Responsibilities: Interacting by phone with customers to provide information in response to inquiries, concerns and questions about their coverage and products Healthfirst offers. Transferring calls from members to proper lines of business such as, Enrollment, Provider Services, Claims, Medical Management, etc. Following-up on customer inquiries and complaints th...

Application Deadline: None

Clinical Quality Manager

Healthfirst - Manhattan, NY

Responsibilities: Lead all assigned network hospitals and large provider groups to improve HEDIS/QARR scores and best member outcome. Monitor provider-specific HEDIS report cards. Identify areas of concern, and raise concerns with management and hospital contacts. Provide assistance with root cause analysis related member l ow quality scores an...

Application Deadline: None

Business Analyst (Billing & Reconciliation Reporting Analytics)

Healthfirst - New York, NY

Application Deadline: None

Business Analyst

Healthfirst - Lake Mary, FL

Responsibilities: Create reports and data extracts against database using MS Excel, MS Access, SAS, Qlikview and Crystal Reports. Create ad hoc reports for upper level management. Design, create, modify, support and maintain daily, weekly and monthly reports for accuracy. Monitor Business Analyst mailbox for report request and take action for completio...

Application Deadline: None

Reassessment Field Performance Supervisor

Healthfirst - New York, NY

Responsibilities: Provides on-site supervision within the Healthfirst coverage area to ensures accurate and comprehensive completion of UAS assessments and required State approved and internal documents. Must be able to travel to all boroughs on a rotation. Oversees required procedures are applied in the field, each member receives an individualized assessment an...

Application Deadline: None

Director, Commercial Sales

Healthfirst - New York, NY

Responsibilities: Directs the marketing, acquisition, and retention efforts of the commercial sales staff both internal and external for a specific geographic area. Oversees assigned territory small businesses, small business associations, business improvement districts, community based organizations, faith based organizations and city agencies that would provide partn...

Application Deadline: None

Support Coordinator, Complete Care SHP Care Management

Healthfirst - Telecommuter

Responsibilities: Communicate with service providers regarding authorizations including, but not limited to, outreach calls and mailings to members and providers, telephonic calls to community-based organizations, calling providers with the pre-certification number, entering cases in CCMS (CareEnhance Clinical Management Software), education material mailings, benefit questions and is...

Application Deadline: None

Reassessment Field Performance Supervisor Bilingual Spanish

Healthfirst - New York, NY

Qualifications: Minimum Qualifications: Associate's Degree in Nursing and New York State (NYS) Registered Nurse(RN) License U.S. based field work experience in any ofthe following areas: Geriatrics, Home Care, Discharge Planning, Case Management or Medical Surgical Nursing. Experience usingthe Mini Mental State Exam (MMSE and Uniform A...

Application Deadline: None