Jobs at Healthfirst
9,756 open positions
Clinical Quality Manager
Company: Healthfirst
Location: New York, NY
Posted Dec 24, 2024
The Clinical Quality Manager role involves working remotely to ensure members receive appropriate services, focusing on improving quality of care through HEDIS, QARR, and Medicare Advantage Star measures. Key responsibilities include interacting with hospitals, providers, and members to enhance care, reviewing billing codes and medical records, attending initiative meetings, conducting on-site visits for provider education, collaborating with departments for member outreach, and assisting in writing articles related to HEDIS, QARR, and health promotions. The role requires travel within the NYC metro area, a clinical license, and multiple years of HEDIS review experience. Healthfirst offers a competitive salary and benefits package.
Sr Mgr, Marketing Implementation
Company: Healthfirst
Location: New York, NY
Posted Dec 24, 2024
The Senior Manager, Marketing Implementation (Technical Project Management) will lead the Marketing Strategy team's operations and project management. Key responsibilities include providing senior-level oversight for project lifecycles, managing team capacity and resources, and collaborating with technical stakeholders. The ideal candidate should have 7+ years of project management experience in a technical marketing environment, expertise in managing complex projects, and proficiency in project management tools. Preferred qualifications include a Bachelor's degree, PMP certification, and experience with Salesforce and MarTech vendor RFPs.
Payment Policy Analyst -100% Remote
Company: Healthfirst
Location: Remote
Posted Dec 24, 2024
The Payment Policy Analyst at Healthfirst is responsible for promoting compliance and regulatory requirements. This role involves developing, drafting, and finalizing reimbursement policies, facilitating the policy process, and conducting industry research. The analyst collaborates with various departments, prepares reports, and ensures adherence to local, state, federal, and Healthfirst-specific guidelines. Minimum qualifications include an associate degree, experience in policy creation, familiarity with reimbursement methodologies, and compliance experience in a managed care environment. Preferred qualifications include a bachelor's degree, project management experience, and proficiency in Microsoft Office tools.
Claims Implementation Analyst
Company: Healthfirst
Location: Remote
Posted Dec 24, 2024
The Claims Implementation Analyst role involves analyzing, implementing, and reporting claims configuration business rules. Key responsibilities include developing and maintaining reporting tools, querying and analyzing data, identifying root causes, and recommending decisions. The role requires project management skills, including planning, deadline setting, and conflict resolution. Familiarity with Medicare, Medicaid, and third-party sources for payment methodologies and claims editing policies is essential. Experience with Microsoft Excel, Access, Crystal Reports, and PowerPoint is required. A Bachelor's Degree is preferred. The position offers a competitive salary and benefits package.
Bilingual Complete Care Specialist (Man\/Can and\/or Fujianese)
Company: Healthfirst
Location: New York, NY
Posted Dec 21, 2024
The Complete Care Specialist is a crucial role responsible for developing and maintaining relationships with potential members for Medicare Advantage and Medicaid Advantage Plus (MAP) plans. They ensure proper enrollment, communicate effectively with various stakeholders, and nurture relationships with community leaders, hospitals, and partners. The role requires adaptability to various software, staying updated on regulations, and participating in networking events. A high school diploma or equivalent, along with relevant sales or customer service experience, is required. Healthfirst offers competitive compensation and benefits, including health insurance, incentive programs, and 401k contributions.
Learning Delivery Specialist
Company: Healthfirst
Location: New York, NY
Posted Dec 24, 2024
The Learning Delivery Specialist will serve as a culture ambassador, implementing and delivering content aligned with enterprise initiatives. They will lead learning projects, designing and developing classroom and virtual events, partnering with subject matter experts. Responsibilities include facilitating learning events, maintaining content, collaborating with business units, managing learning environments, and staying current with policies. The role requires expertise in learning delivery, adult learning principles, and Microsoft Office. Preferred qualifications include a Bachelor's degree, experience in training or healthcare sales, LMS familiarity, and facilitation certifications.
Episodic Support Coordinator UM\/CM
Company: Healthfirst
Location: Remote
Posted Dec 24, 2024
The Support Coordinator role involves assisting care/case managers with non-clinical tasks such as case and event creation, authorization management, telephonic outreach, and handling member mailings. The position requires excellent customer service skills, proficiency in Microsoft Office Suite, and experience in a fast-paced environment. Preferred qualifications include language preferences and experience in managed care or healthcare industries. The role offers competitive compensation and benefits, with a hiring range varying by location. Healthfirst is an equal opportunity employer.
Manager, Care Management
Company: Healthfirst
Location: Remote
Posted Dec 24, 2024
This job description outlines the role of a Care Management Manager, including team supervision, care coordination, and qualifications. It details responsibilities, required licenses, and compensation ranges in New York and other locations.
Director, Federal Government Relations | Hybrid NYC
Company: Healthfirst
Location: Remote
Posted Dec 21, 2024
Healthfirst is seeking a Director of Federal Government Relations to execute a comprehensive government affairs strategy, advancing the organization's mission and goals with federal elected officials and agencies. The role involves developing and implementing a strategy to promote Healthfirst's advocacy objectives, maintain its presence as a thought leader in Medicare, and ensure its priorities are well-established in the legislative process. The ideal candidate should have a Bachelor's degree in public policy, government, health policy, or a related field, and at least 7+ years of government and/or health policy-related experience. They must have a deep understanding of the federal policymaking process and Medicare Advantage policy. The role is a hybrid position, requiring the candidate to work from Healthfirst's NYC office 3 days a week and travel to Washington, DC as needed. The hiring range is $124,400 - $230,690, depending on the location.
Mgr Clinical
Company: Healthfirst
Location: Remote
Posted Dec 24, 2024
The Manager of Care Management supervises a team of RN's, Social Workers, and Coordinators to ensure appropriate services and care management for members across Healthfirst product lines like CompleteCare, Medicaid, and Medicare. The role involves developing team goals, conducting performance reviews, and ensuring an atmosphere of open communication and empowerment. The Manager oversees care plans, collaborates with clinical operations, and analyzes data for improvement. Minimum qualifications include an Associate's degree and specific licenses based on the care type. Preferred qualifications include CCM certification, supervisory experience, and knowledge of health insurance regulations. The role involves ensuring regulatory compliance, managing resources, and setting goals. The hiring range is competitive with benefits.
Support Coord
Company: Healthfirst
Location: Remote
Posted Dec 21, 2024
The Support Coordinator role involves assisting care/case managers with non-clinical tasks such as creating cases, handling outreach, managing mailings, and faxing requests. Key responsibilities include managing caseloads, handling member calls for benefit inquiries, scheduling appointments, and documenting accurate member information. The role requires timely communication, monitoring of member needs, and escalation of issues as necessary. Healthfirst offers competitive compensation and benefits, including medical, dental, vision coverage, and 401k contributions. The company is an equal opportunity employer.
Clinical Pharmacist, Pharmacy Engagement - Hybrid NY
Company: Healthfirst
Location: New York, NY
Posted Jan 13, 2025
The Clinical Pharmacist role at Healthfirst involves collaborating with various teams to manage drug spend, reduce medical costs, and improve quality measures. Key responsibilities include establishing relationships with partner hospitals and community pharmacies, providing strategic recommendations to decrease pharmacy costs, and communicating formulary changes. The role requires strong communication skills, proficiency in Microsoft Office, and the ability to travel throughout New York City and Long Island. Minimum qualifications include a registered pharmacist license, strong communication skills, and proficiency in Microsoft Office. Preferred qualifications include a PharmD degree, managed care pharmacy experience, and Medicare Stars or HEDIS experience.