Jobs at Healthfirst
9,756 open positions
Director, Performance Improvement
Company: Healthfirst
Location: New York, NY
Posted Oct 06, 2024
The Director of Performance Improvement is a key role responsible for developing and implementing Performance Improvement (PI) initiatives to enhance Healthfirst's business processes, performance, and productivity. This individual collaborates with operations and business leadership to establish, execute, and manage PI strategies. They lead a team of performance improvement experts, oversee Healthfirst's Six Sigma certification program, and manage staff within the department. Key responsibilities include identifying operational problems, developing PI solutions, leading cross-functional teams, and coaching business teams on performance improvement tools. The ideal candidate holds a Bachelor's degree, has experience managing projects using Six Sigma/Lean methodologies, and possesses industry work experience in healthcare. A Master's degree and healthcare industry experience are preferred. The hiring range for this position is $124,400 - $230,690, depending on location and qualifications.
Care Manager - Complex Care
Company: Healthfirst
Location: Remote
Posted Oct 06, 2024
The Complex Care Manager role involves planning and managing behavioral and physical care, collaborating with members and healthcare teams, and addressing coordination of healthcare services. Duties include advocating for beneficiaries, conducting assessments, developing care plans, generating referrals, liaising with service providers, and documenting encounters. Minimum qualifications include a NYS RN license, while preferred qualifications include strong interpersonal skills, fluency in certain languages, knowledge of community health practices, and experience with electronic documentation systems. The hiring range is competitive, with benefits including medical, dental, vision coverage, and 401k contributions.
Field Service Agent - Brooklyn, NY - Bilingual English\/Haitian Creole
Company: Healthfirst
Location: Remote
Posted Oct 05, 2024
Healthfirst is seeking a bilingual Field Service Agent to work in Brooklyn. The role involves providing high-quality customer service to providers and members, managing face-to-face encounters, de-escalating dissatisfied situations, and building trust through open communication. The agent will also assist with contact center operations, participate in community events, and comply with HIPAA requirements. Minimum qualifications include a high school diploma, customer service experience, and proficiency in Microsoft Office Suite. Preferred qualifications include an associate degree, bilingual skills, and healthcare industry experience.
HIV\/ AIDS Care Manager
Company: Healthfirst
Location: Remote
Posted Oct 05, 2024
The Care Manager role involves planning and managing behavioral and physical care for members, facilitating medical attention, and addressing identified needs across the care continuum. The 'Complex Care' Care Manager takes a holistic approach to managing care for members with chronic diseases. Responsibilities include advocating for beneficiaries, conducting assessments, developing care plans, generating referrals, collaborating with healthcare teams, and documenting encounters. Minimum qualifications include NYS RN or LCSW, while preferred qualifications include strong interpersonal skills, fluency in certain languages, knowledge of community health practices, and experience with care management systems. The role offers a competitive salary and benefits package.
Remote Manager Clinical A&G
Company: Healthfirst
Location: Remote
Posted Oct 09, 2024
The Manager, Clinical Appeals & Grievances is a leadership role responsible for overseeing a dynamic team, standardizing processes, and ensuring high-quality production and compliance. This individual will work closely with multiple leaders, manage a team of specialists, and drive strategic thinking to address challenges. They will also maintain vendor relationships, diagnose operational challenges, and develop innovative tools for Appeals & Grievances functions. The role requires a Bachelor's degree, RN or LPN, and experience in utilization management or appeals processing. Preferred qualifications include clinical practice experience, understanding of Utilization Review Guidelines, and MBA or master's degree in healthcare administration.
Per Diem, Assessment RN, Bronx, NY
Company: Healthfirst
Location: New York, NY
Posted Oct 06, 2024
The Assessment Nurse role involves conducting home assessments for prospective and current members, determining enrollment and continued eligibility, and coordinating with the Care Management Team. The position requires a New York State RN license, ability to travel to Bronx NY, and preferred experience in geriatrics, home care, discharge planning, case management, and medical surgical nursing. The role offers a competitive salary range and comprehensive benefits package. Healthfirst is an equal opportunity employer.
Sr QA Analyst (Remote)
Company: Healthfirst
Location: Remote
Posted Oct 03, 2024
The Senior Quality Assurance (QA) Analyst position at Healthfirst involves conducting software testing, planning, and analyzing results to ensure compliance with specifications and IS standards. The role requires preparing reports, conferring with programmers, business analysts, and upper management, and ensuring standardized methods and procedures are used for efficient and prompt handling of QA testing activities. The candidate should have a heavy background in HP test tools and intermediate knowledge of test automation. The individual will provide technical solutions to difficult problems, embody Healthfirst's Culture Drivers, and ensure a high level of Quality Assurance in a more efficient method. The role involves developing test plans, test strategies, end-to-end test plans, test cases/scenarios, and QA metrics. The candidate must have experience in structured testing methodology, with a proven ability to break down business requirements into high and detailed test cases and test scenarios. Experience with Healthcare, specifically in Claims, Enrollment, EDI/BizTalk applications, is a plus. The role also involves working closely with business analysts, a diverse group of users, IS Management, and application developers, and assisting IS and Business in using and adapting QA Methodologies and HPALM.
Manager, Actuarial Services
Company: Healthfirst, Inc
Location: New York City, NY
Posted Oct 04, 2024
The job posting is for a Manager of Actuarial Services position at Healthfirst Management Services. The job involves coordinating and performing analysis of forecasts and budgets, monitoring product performance and trends, and managing actuarial analysis and modeling. The job requires a bachelor's degree in actuarial science or a related field, experience in the actuarial field, and proficiency in programming languages such as SAS, SQL, or Python.
Director, Claims Modernization, Claims Solution Lead
Company: Healthfirst
Location: New York, NY
Posted Oct 08, 2024
The Director, Claims and Provider Payment Modernization will lead initiatives for modernizing claims processing, ensuring regulatory compliance, and improving work output. This role involves strategic planning, cross-functional collaboration, and managing a team. The ideal candidate will have a Bachelor's degree, experience in change initiatives, and strong interpersonal skills. A Master's degree, healthcare payor experience, and Agile methodologies knowledge are preferred. Healthfirst offers competitive compensation and benefits.
QA Business Analyst
Company: Healthfirst
Location: New York, NY
Posted Oct 05, 2024
The Business Analyst role involves reporting, business process review, and data analysis to ensure operational effectiveness. Key responsibilities include developing and maintaining reporting tools and processes, querying and analyzing data, identifying root causes, and recommending decisions. The role also involves project management, communication with various levels of the organization, and ensuring compliance with regulatory requirements. The ideal candidate should have experience with data querying and manipulation, MS Excel functions, and data analytics tools. A Bachelor's degree or higher, preferably in a relevant field, and relevant work experience in healthcare are preferred. This is a collaborative team environment requiring strong communication, interpersonal, and multi-tasking skills.
Director, Claims Modernization, Claims Solution Lead
Company: Healthfirst, Inc
Location: New York City, NY
Posted Oct 04, 2024
The job posting is for a Director of Claims and Provider Payment Modernization, responsible for planning, organizing, and implementing initiatives to support the Claims and Provider Payment Modernization program. The role requires strong leadership, communication, and analytical skills, with a focus on ensuring regulatory compliance and improving work quality.
Retention Advocate Team Lead
Company: Healthfirst
Location: New York, NY
Posted Oct 08, 2024
The Retention Advocate Team Lead oversees a team responsible for assisting Healthfirst members in obtaining financial entitlements, enabling them to maintain independence. The team uses various electronic databases and tools, including Salesforce and Outlook, to manage member information and application processes. The role involves supervising team members, coordinating workflows, tracking application outcomes, and preparing monthly reports. The position requires staying updated on Medicaid/Medicare/HMO laws and contributing to continuous performance improvements.