Jobs at Healthfirst - Page 2

103 job openings

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Displaying results 16 - 30 of 103

QA Analyst

Healthfirst - New York, NY

Responsibilities: Project Estimation Support Requirements and Specifications Analysis Test Strategy Test Planning Test Design/Preparation -Test Cases/Scripts both manual / automated Test Execution and Defect Reporting and Management Test Cases/Scripts Maintenance Support both major and one-off projects ...

Application Deadline: None

Relationship Coordinator, Sales - Mandarin/Cantonese

Healthfirst - New York, NY

Responsibilities: Working under the direction of the Relationship Manager, maneuvers multiple tasks independently with a fast-paced proactive vs. reactive approach to changing priorities, call volume and telemarketing call and appointment goals. Attention to managing many details and remaining focused in an environment with distractions. Receives and screens all ...

Application Deadline: None

Health Care Fraud Investigator

Healthfirst - New York, NY

Responsibilities: Conduct in-depth research and review of suspected fraudulent or abusive patterns to develop sufficient evidence to conclusively establish facts involving members, providers or other entities Collect, utilize and interpret data obtained from a variety of computer generated reports and other sources, thereby identifying and documenting questionable patterns ...

Application Deadline: None

Assistant Director Care Management

Healthfirst - New York, NY

Responsibilities: Participate in all aspects of personnel management to ensure appropriate staffing, orientation, support, discipline and timely performance appraisals. Ensure that probationary and annual performance appraisals are completed in an objective manner; that employees are encouraged to complete their self-evaluation and that appraisals are completed in a timely ...

Application Deadline: None

Senior Actuarial Analyst

Healthfirst - New York, NY

Responsibilities: Perform Medicare Advantage pricing, bids, modeling and forecast Handle premiums, claims, enrollment, and administrative expense data for reports to government and regulatory entities (such as CMS, NYSID, NYDOH, etc.) and routine internal reports Work on data and analysisincorporated into high level corporate reporting and monitor experiencefor M...

Application Deadline: None

Director Enrollment

Healthfirst - New York, NY

Responsibilities: Duties Responsibilities: Define and establish production metrics and quality standards for the Enrollment department. Develop an effective reporting infrastructure through regular monitoring and analysis of quality and production outcomes and establish corrective action plans as necessary. Manage, develop and engage e...

Application Deadline: None

Director, Appeals and Grievances

Healthfirst - New York, NY

Responsibilities: Day to day monitoring of process compliance against all regulatory guidelines and quality targets. Preparation and presentation of appeals for fair hearing in collaboration with legal and utilization review staff to support UM determinations. Identify opportunities for improvement in processes within AG and other HF departments based on Appeals,...

Application Deadline: None

Business Analyst (Claims Reporting-SAS coding)

Healthfirst - New York, NY

Responsibilities: Analysis, Reporting and Performance Improvement: Develop and maintain new and existing reporting tools, databases and processes. Analyze various types of data and processes in a versatile manner and present findings and recommendations in a professional manner. Query and manipulate data to root cause, trend, summarize findings an...

Application Deadline: None

Project Coordinator

Healthfirst - New York, NY

Responsibilities: Create and maintain project schedules and other required project documentation using corporate project management tools and principles. Facilitate meetings and conference calls with project participants acting in a consultative capacity. Capture and summarize meeting objectives and outcomes, and outline key decisions and action items. Assist wit...

Application Deadline: None

ETL Developer

Healthfirst - New York, NY

Responsibilities: Design and implementation of complex data integration that are innovative, scalable and high performing within Informatica PowerCenter and PowerExchange. Perform systems and data analysis to implement Informatica mappings and workflows, shell scripts and stored procedures. Applies data analysis, data cleansing, data matching, exception handling,...

Application Deadline: None

Nurse Care Manager - SHP

Healthfirst - Telecommuter

Responsibilities: Maintains ongoing telephonic communication with members and their caregivers to ensure a safe and appropriate care plan. Member family education re: health management and community resources. Appropriately manages member care including but not limited to; coordination of benefits (Medicare Medicaid), coordinating monitoring all skilled services,...

Application Deadline: None

Human Resources Communications Manager

Healthfirst - New York, NY

Responsibilities: Directs the writing, editing and distribution of a wide range of materials, including newsletters, email blasts, brochures, flyers, corporate publications and other collateral Distributes executive messages, prepares presentations and internal memos and presents drafts and ideas to management as required Develops policies, procedures and job aid...

Application Deadline: None

Appeals and Grievances, Clinical Specialist

Healthfirst - Telecommuter

Responsibilities: Ensure that appeals and grievances are categorized and processed within New York and New Jersey State and Federal timeframes. Enter all appeals and grievances in the Units software tracking system. Identify potential quality issues and initiate investigations. Refer substantiated quality of care issues to the Quality Improvement and Credentialin...

Application Deadline: None

Enrollment Medicaid Specialist, bilingual Russian

Healthfirst - New York, NY

Responsibilities: Conducts individual pre-enrollment screening: Meets with individuals who may qualify for enrollment in Senior Health Partners throughout the 5 boroughs, Westchester and Nassau County. Explains the program features, benefits and commitments, including explanation of the Member Handbook. Conducts pre-screening for financial eligibility.

Application Deadline: None

Outbound Verification Representative

Healthfirst - Lake Mary, FL

Responsibilities: Calling provider offices to verify data that is currently contained in the Healthfirst Provider Database (MHS). Updating MHS and/or other systems with correct provider information (At times, the unit may be involved with complete loads of new providers or work on large data entry projects) Participating in Access and Availability survey by makin...

Application Deadline: None