Jobs at Healthfirst
9,756 open positions
Principal Cloud Database Engineer - Remote
Company: Healthfirst
Location: Remote
Posted Dec 20, 2024
The Principal Cloud Database Engineer is a crucial role in Healthfirst's cloud and operational excellence strategy. This position involves managing enterprise solutions in both public and private clouds, automating system deployment, and configuration management tasks. The engineer designs, develops, and implements cloud-based database solutions, manages database instances, and ensures high availability, performance, and data integrity. They also focus on performance tuning, data security, compliance, monitoring, capacity planning, and automation. Collaboration with application teams, infrastructure teams, and stakeholders is essential for understanding requirements, providing guidance, and ensuring effective integration. Continuous learning and adaptation to evolving cloud environments and database technologies are also required.
Clinical Auditor: Appeals and Grievances
Company: Healthfirst
Location: Remote
Posted Dec 20, 2024
The Clinical Auditor role at Healthfirst involves auditing clinical teams and vendors to ensure operational efficiency, regulatory compliance, and quality standards. Duties include maintaining tracking tools, analyzing performance data, developing improvement strategies, and applying clinical thinking skills. Required qualifications include a NYS LPN or RN license and an unexpired NYS ID. Preferred qualifications include relevant work experience, knowledge of managed care regulations, and experience with specific systems. The role offers competitive compensation and benefits, with a hiring range from $71,594 to $116,480. Healthfirst is an equal opportunity employer.
Sr. Workforce Effectiveness Data Analyst
Company: Healthfirst
Location: Remote
Posted Dec 20, 2024
The Senior Strategic Data Analyst at Healthfirst Operations is tasked with fostering a data-driven culture, leveraging technology and analytics to enhance efficiency. This role involves developing insights through advanced analytical tools, creating repeatable analytics for leadership, and designing data models and dashboards. The analyst also contributes to complex algorithm development, statistical predictive modeling, and ETL processes. They are expected to critically analyze business operations, identify improvement opportunities, and communicate findings confidently. A Master's degree, proficiency in data analysis tools, and experience with AWS are preferred. Healthfirst offers competitive compensation and benefits.
Manager, Actuarial Services
Company: Healthfirst
Location: New York, NY
Posted Dec 20, 2024
The Manager of Actuarial Services is tasked with coordinating and performing analysis of the Forecast and Budget for all lines of business, monitoring product performance and trends monthly. This role involves managing actuarial analysis, modeling, and deliverables related to Medical Trend across all Healthfirst lines of business. Key responsibilities include building and maintaining models for analyzing historical medical trend, monitoring drivers of medical trend, tracking industry trend resources, developing projection trend assumptions, and participating in various meetings. The ideal candidate should have a Bachelor's degree in actuarial science or related field, experience in the actuarial field related to Medical Trend, experience with medical claims codes and datasets, and proficiency in programming/coding, preferably SAS, SQL, or Python. Healthfirst offers a competitive compensation package and benefits.
Entitlement Advocate
Company: Healthfirst
Location: New York, NY
Posted Dec 20, 2024
The Enrollment Medicaid Specialist at Healthfirst is responsible for assisting members with Medicare Advantage Plan (MAP), Managed Long-Term Care (MLTCP), FIDA, and Nursing Home enrollment, ensuring they obtain and retain financial entitlements. This role involves conducting pre-enrollment screenings, identifying enrollment obstacles and opportunities, and participating in continuous performance improvement. The specialist completes Medicaid applications, tracks Medicaid status, and maintains records in CCMS Management Information System (MIS). They also serve as a resource for Medicaid and other savings programs, and act as a member advocate, maximizing support networks and obtaining needed services. The role requires mastery of various electronic databases and tools, and maintaining the highest level of integrity.
Manager, Actuarial Services - Medicaid
Company: Healthfirst
Location: New York, NY
Posted Dec 20, 2024
The Manager of Actuarial Services is tasked with coordinating and performing analysis of the Forecast and Budget for all lines of business, focusing on Healthfirst's Medicaid lines. This role involves monitoring experience, analyzing impacts of premium rate changes, and researching the Medicaid market landscape. The individual will also provide input to other actuarial functions, analyze product performance, and develop business plans. Required qualifications include a degree in Actuarial Science, Math, Economics, or Finance, experience in the actuarial field related to Medicaid, and proficiency in programming/coding, preferably SAS, SQL, or Python.
Team Lead Workforce Effectiveness
Company: Healthfirst
Location: Sebring, FL
Posted Dec 20, 2024
The Team Lead of Workforce Effectiveness at Healthfirst is a pivotal role responsible for overseeing various functions including Time and Attendance, Planning, Scheduling, and Real-time Analytics. This role ensures operational excellence, adherence to SLAs, and aligns strategies with business objectives. Key duties involve leading the team, developing forecasting strategies, enhancing operational efficiency, and collaborating with stakeholders. The ideal candidate should have a high school diploma, experience in workload planning, SQL, data analysis, and contact center operations. Preferred qualifications include a Bachelor's degree, call center experience, and healthcare industry knowledge.
Sr. Product Specialist
Company: Healthfirst
Location: New York, NY
Posted Dec 20, 2024
The Senior Specialist of Product Shared Services (Product Optimization) is a key role responsible for leading special initiatives, collaborating with internal partners, and ensuring content accuracy and business opportunities maximization. They participate in product workgroups, work closely with cross-functional teams, and plan, schedule, and report on project activities. The role requires excellent communication, analytical skills, cross-functional collaboration, strategic thinking, and project management. A Bachelor's degree or relevant experience is required, with a Masters degree preferred. Healthfirst offers competitive compensation and benefits, and is an equal opportunity employer.
Care Manager - 100% Remote
Company: Healthfirst
Location: Remote
Posted Dec 19, 2024
The Care Manager role is fully remote and involves planning and managing behavioral and physical care for members. The Care Manager advocates, informs, and educates beneficiaries, conducts assessments, develops care plans, and generates referrals to providers and resources. They liaise between service providers and coordinate with the health care team to ensure care is person-centered and maximizes member health outcomes. Minimum qualifications include a NYS RN, LCSW, or LMSW for Medical Care Management, or relevant licenses for Behavioral Health Care Management. Preferred qualifications include strong interpersonal skills, fluency in multiple languages, and experience with community health practices for frail adults. The hiring range is competitive, with benefits including medical, dental, vision coverage, and 401k contributions.
Medicare Product Implementation & Optimization (MPIO) Specialist (Operations)
Company: Healthfirst
Location: New York, NY
Posted Dec 20, 2024
The Medicare Product Implementation Specialist at Healthfirst is responsible for assisting with the development, implementation, and monitoring of new and existing products across Medicare and Integrated Products. This role involves working with cross-functional teams to provide support through operational development, project management, and end-to-end implementation of business processes. Key responsibilities include implementing new benefits and services, enhancing existing processes, and working on enterprise projects and ad-hoc initiatives. The ideal candidate should be a results-driven, creative, detail-oriented individual with excellent communication skills. Minimum qualifications include a Bachelor's Degree and 3-5 years of relevant experience. Preferred qualifications include healthcare insurance and related experience, strong organizational and project management skills, and excellent written and verbal communication.
Sr Mulesoft Application Developer
Company: Healthfirst
Location: Remote
Posted Dec 20, 2024
The Senior Application Developer - (MuleSoft) is a team lead role requiring 3-5 years of MuleSoft development experience, 3 years of SQL experience, and 2 years each in Python, CI/CD, and Middleware. The role involves collaborating within an Agile framework, applying API-led connectivity concepts, designing and developing enterprise services, and participating in integration projects. The ideal candidate should have working knowledge of MuleSoft connectors, AWS services, Java, and Git, with a Bachelor's degree or equivalent work experience. Preferred qualifications include Scrum master experience, Informatica platform knowledge, and healthcare domain expertise. Healthfirst offers a competitive salary and benefits package.
Senior Social Media Manager
Company: Healthfirst
Location: New York, NY
Posted Dec 20, 2024
Healthfirst is seeking a Senior Social Media Manager with extensive experience in digital communications and social media. The role involves developing and implementing a comprehensive social media strategy, managing content creation, overseeing community management, and staying updated with the latest social media trends. The ideal candidate should have a strong understanding of various social media platforms, excellent leadership skills, and the ability to analyze and interpret social media data. The position requires evening and weekend work due to the 'always on' nature of social media.