Jobs at Healthfirst - Page 5

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Education Manager, Medical Management

Healthfirst - Telecommuter

Responsibilities: Oversees the training of new hire staff related to the provision of the basic departmental functions which include: pre-certification, concurrent review, discharge planning, case management, disease management, appeals processing and referrals, Healthfirst and SHP standards and the rules/regulations set forth by the Company, the Department of Health and state and fed...

Application Deadline: None

Program Manager

Healthfirst - New York, NY

Responsibilities: Planning, directing and coordinating project activities through the entire project life cycle (from initiation to close). This includes setting clear project milestones and deliverables, communicating goals, objectives and responsibilities, keeping the project focused in terms of scope, schedule, communication and risk. Creating and executing project plans...

Application Deadline: None

Senior Analyst, Internal Controls

Healthfirst - New York, NY

Responsibilities: Participate in the identification and rationalization of key controls. Such activities may include: Reviewing existing documentation, including MS Word-based Process Narrative, and Excel-based Risk and Control Matrix (RCM). Reviewing prior-year testing to determine if some controls should be combined or eliminated. Discussing key...

Application Deadline: None

Social Worker -SHP

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

Quality Improvement Representative

Healthfirst - Lake Mary, FL

Responsibilities: Evaluates Provider Services calls in accordance with departmental quality standards. Reviews findings with representatives and provides coaching and feedback as needed. Communicates observations and results of scores to team supervisors and QI management. Identifies trends, conducts root cause analysis, and makes recommendations for improvement ...

Application Deadline: None

Healthcare Analyst - Hospital Reporting

Healthfirst - New York, NY

Responsibilities: Provide support to the Provider Organizations performance improvement work groups. Monitor costs and revenue trends for Provider Organizations and assist in understanding trends. Understand and analyze impacts of new program changes. Responsible for creating, modifying, and updating analysis for Provider Organizations. Resp...

Application Deadline: None

Network Management Representative

Healthfirst - New York, NY

Responsibilities: Developing Maintaining positive relationships with physicians, providers, and practice managers within the provider network Providing high quality service to physicians, providers, and practice managers Ensuring Providers' issues and needs are responded to in a timely and accurate fashion. Ability to review a Provider issue, identify root cause,...

Application Deadline: None

Informatics Nurse

Healthfirst - New York, NY

Responsibilities: Provides prospective, concurrent and retrospective analysis utilizing the most current data sets available to identify and support improvement activities designed to enhance clinical programs within Healthfirst's Medical Management/Appeals and Grievances Departments. Works closely with the Informatics team to identify and monitor the quality of data imported and util...

Application Deadline: None

Performance Improvement Specialist

Healthfirst - New York,Us, NY

Responsibilities: Completing performance improvement projects to meet deadlines and expected goals/ deliverables (i.e. facilitating team meetings, completing root cause analyses, compiling improvement opportunities, presenting project findings to the executive steering committee, as well as the project sponsors/owners). Developing and maintainingvarious required performance...

Application Deadline: None

Programmer Analyst

Healthfirst - New York, NY

Responsibilities: The Senior Programmer Analyst develops and translates designs and specifications into various systems following programming standards. Demonstrates a proficiency in at least one of Healthfirsts programming languages (i.e., SQL. Server Integration Services (SSIS) or TSQL) while facilitating the transition of programs from development into production. Partic...

Application Deadline: None

Applications Support Analyst

Healthfirst - New York, NY

Responsibilities: Duties Responsibilities: Should be able to gain application skills via online training or via other resources within the IT division to serve as SME. Monitor Help Desk queue for new tickets and resolve issues to completion. Seek guidance and directions from other Analysts. Make sure that help desk tickets are register...

Application Deadline: None

Information Security Architect

Healthfirst - New York, NY

Responsibilities: Plan, design and implement security solutions, tools, and monitoring systems. Review new systems designs and major modifications for security implications prior to implementation. Document, analyze,and report on IS business processes to recommend security enhancement and improvements. Develop an organizational risk assessment framework based on HIPAA, NIST...

Application Deadline: None

Healthcare Analyst - SAS Progammer

Healthfirst - New York, NY

Responsibilities: Create, maintain and optimize SAS programs to support Finance Analysis data process. Document all coding, methodology and assumptions, data issues and report results for each analysis. Utilize research methods to analyze various data sets to support material financial adjustments for all Healthfirst products. Gather data and conduct a...

Application Deadline: None

Director - Operations Internal Audit, QA and Dedicated Testing

Healthfirst - New York, NY

Responsibilities: 1. Strategic Planning: Build, manage and develop an internal operations audit, quality assurance and dedicated testing department to meet the diverse and dynamic needs of a growing, evolving organization. Oversee all internal operations audit, quality assurance processes and dedicated testing processes to ensu...

Application Deadline: None

Director Medical Management - Commercial Business

Healthfirst - Telecommuter

Responsibilities: Develop a staffing model, reporting structure and metrics in order to monitor and measure productivity and departmental performance. Maintain NCQA readiness, accreditation and ongoing compliance. Collaborate with Talent Acquisition on the hiring of approved positions, and execute new needs requests for the department in order to support the grow...

Application Deadline: None