Jobs at Healthfirst - Page 3

103 job openings

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Displaying results 31 - 45 of 103

Clinical Nurse Auditor

Healthfirst - Telecommuter

Responsibilities: Review and identify claims to authorization mismatches for skilled services. Review all skilled nursing, hospital stays, skilled nursing facility claims and durable medical equipment necessity matching claims to events in CCMS. Perform multipleauditingtasks to ensure aappropriatenessof care. Review documentation in (Private Health Inf...

Application Deadline: None

Relationship Manager, Call Center

Healthfirst - New York, NY

Responsibilities: Building Maintaining effective long-term relationships and high level of satisfaction with key senior leveldecision makers and influencers at an assigned group of customer accounts that typically includes a limited number of major strategic customers within a geographic or industry focus Will manage a team of Supervisors, Relationship Coordinators, Sales r...

Application Deadline: None

Actuarial Analyst

Healthfirst - New York, NY

Responsibilities: 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. Perform riskscore analytics Work on data incorporated into high level corporate reporting and monitor experience of all lines of business. Prepare period...

Application Deadline: None

Director , Product Management - Dual Eligible Medicare/Medicaid

Healthfirst - New York, NY

Responsibilities: Develop strategic planning initiatives incorporating integrated products. Provide a resource to all operational departments regarding all integrated products. Collaborate with State legislatures and regulators to understand and guide the development of the integrated products specific to plan design and roll-out. Provide strategic dir...

Application Deadline: None

Supervisor, Appeals & Grievances

Healthfirst - Ny, Telecommuter

Responsibilities: Supervisors staff to ensure timely and accurate processing and resolution of appeals, grievances and complaints. Monitors daily performance of staff related to timeliness of acknowledgements and resolutions of appeals, complaints, grievances for NY Medicare, Medicaid, Family Health Plus (FHP), Child Health Plus (CHP), Qualified Health Plan/Exchange (QHP) a...

Application Deadline: None

Resolution Specialist, Appeals & Grievances

Healthfirst - Telecommuter

Responsibilities: Receives calls through Interactive expedited appeal/Livanta call line and set up events with appropriate drop downs for clinical specialist. Creates events in our Clinical Management Software System (CCMS) for each inquiry/complaint received. Ensures that inquiries are resolved verbally to our members and providers within 24 hours of receipt of ...

Application Deadline: None

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

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

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

Clinical Quality Manager HEDIS/QARR RN, LPN OR LMSW

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

Data 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