Jobs at Healthfirst - Page 3

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Displaying results 31 - 45 of 98

Business Analyst Manager

Healthfirst - Lake Mary, FL

Responsibilities: Managing the teams progress on various daily report requests, projects, and testing to ensure quality and deadlines are met. Monitoring Business Analysts activities to ensure quality control and work is met, as well as coach, develop and conduct performance evaluations for each individual. Leading organizational and departmental reporting develo...

Application Deadline: None

Writer/Editor, Clinical Correspondence Unit

Healthfirst - New York, NY

Responsibilities: Performs daily reviews of manual letters produced from CCMS to member and providers to ensure adherence to Article 44 and 49 of the NY State Public Health Law and Appendix F, Medicare Managed Care Manual Chapter 13 and commercial contracts and others as necessary. Ensure compliance to Healthfirst corporate branding requirements. Conducts quality...

Application Deadline: None

Nurse Care Manager Welcome Team

Healthfirst - New York, NY

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

Sr. Biztalk Developer

Healthfirst - New York, NY

Responsibilities: Responsible for working with Project Manager, Architect and lead the design, development and implementation of EAI framework, infrastructure components and application integration solutions based on the requirements and the overall technical architecture. Design and develop integration solutions using service oriented architecture (SOA) based, industry sta...

Application Deadline: None

Sr. Ancillary Services Contractor

Healthfirst - New York, NY

Responsibilities: Identify cost of care savings opportunities by analyzing practice patters, referral practices and services. Recommend policy changes and claims system changes to pursue cost savings. Review post implementation results to ensure projected cost savings are realized. Improve HEDIS/QAAR and Medicare Star ratings. Recruit, contract and manage an Ancillary Provi...

Application Deadline: None

Senior Manager, Pharmacy Quality

Healthfirst - New York, NY

Responsibilities: Duties and Responsibilities: Identifies, implements and leads initiatives to drive pharmacy quality performance measures related to STARS and HEDIS measures as set forth by Federal and State regulatory agencies. Serves as the Subject Matter Expert (SME) within Healthfirst for Pharmacy-related quality measures. ...

Application Deadline: None

Quality Assurance Supervisor

Healthfirst - New York, NY

Responsibilities: Review QA project estimation Manage QA project portfolio and across project teams QA resources Interact with management team Mentor QA staff on the project team and help facilitate/mitigate issues Monitor project deliverables, prioritizes activities to meet implementation date ...

Application Deadline: None

HR Concierge

Healthfirst - New York, NY

Responsibilities: Employee Assistance serve as a primary interface and first line resource for employee questions, inquiries, walk-ins or general information on many topics regarding the employee life cycle. Assist employees through triage, research, resolution, education or redirect to appropriate Healthfirst areas. Some areas of focus include, but not limited to:

Application Deadline: None

Educator Clinical RN

Healthfirst - New York, NY

Responsibilities: Duties and Responsibilities: Successful candidate is the first source of job-related information and is required to train/teach about products, processes and policy information at the onset of the hiring process and on a continuous need basis to help current Healthfirst employees stay abreast of evolving information as well as improve the ...

Application Deadline: None

VP, Claims Operations

Healthfirst - New York, NY

Responsibilities: Strategic Business Management: In conjunction with Healthfirst and Operations leadership, establishes and communicates current and long range department goals and objectives and monitors results on a monthly basis, adjusting plans and performance expectations to achieve targeted results. Provides strategic guidance, direction and manag...

Application Deadline: None

Account Receivable Analyst

Healthfirst - New York, NY

Responsibilities: Generate and review State billing file for all Healthfirst products. Ensure billed records are accurate based on approved contracted rates from Department of Health. Correct any errors from exception reports. Identify and bill Kick events (Maternity, Newborn and Low Birth Events). Maintain the infrastructure of Paid Claim support files used to support bill...

Application Deadline: None

Data Analyst

Healthfirst - New York, NY

Responsibilities: Analyze and reconcile premium revenue and remittance status. Account for rate changes across all product lines. Support and report Accounts Receivable sub-ledger aging and collections. Create reports using SAS to assist in reconciliations and assist the team to create data driven processes that improve efficiency of monthly close processes. Collect and ana...

Application Deadline: None

Business Analyst

Healthfirst - Telecommuter

Responsibilities: Implements system processes for new corporate and regulatory requirements. Coordinates integration of multiple systems with outside entities and inside departments. Responsible for implementing new software and testing existing software used by the Medical Management and Appeal and Grievances Departments. Represents Medical Management...

Application Deadline: None

Social Worker- Welcome Team

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

Behavioral Health Representative

Healthfirst - New York, NY

Responsibilities: Assist in the development and recruitment of BH network providers base don department needs to support (HARP) requirements based on the anticipated needs of special populations, including, but not limited to: Transition age youth with BH needs; Adults and transition age youth identified with First Episode Psychosis (FEP); Individuals with Intellectual and Development...

Application Deadline: None