Jobs at Healthfirst

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Project Specialist - Credentialing & Delegate Oversight

Healthfirst - New York, NY

Responsibilities: Credentials HFNY Vendors and Facilities as well as Level III Providers while ensuring all credentialing documents are complete and accurate in accordance with established credentialing policies and procedures.Completes data input of vendors in Excel, creates spreadsheets and runs reports as needed. Creates mail merge documents using MS Word, and is re...

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. Respond to ad-ho...

Hospital Network Account Director

Healthfirst - New York, NY

Responsibilities: Develop trusting and long-term relationships with Healthfirts' PPS partners Hospital/system Account expertise and deep understanding of customer and provider needs in order to execute on Healthfirst DSRIP strategy in partnership with the PPS's affiliated with our sponsor hospitals Leads collaborative strategic planning ...

Regional Director - Hospital Network Management

Healthfirst - New York, NY

Responsibilities: Develop, align and leads the execution of the regional network strategy to drive network development and member acquisition, profitability, growth and competitive advantage in the region. Actively participates on the Sales, Quality and Financial analysis leadership strategy teams. Develops a deep understanding of the regional ...

Service Coordinator, UM

Healthfirst - New York, NY

Responsibilities: Member outreach to inform the member of changes in level of service up to and including reduction of services. Create authorizations for personal care aides and other services quickly and efficiently. Notifies supervisor /manager of all member issues and concerns. Arrange home care/health services as approved by medical director based on medical...

Regulatory Specialist

Healthfirst - United States of America

Responsibilities: Meets with Regulatory to organize pre-survey deliverables and conduct pre-survey reviews of materials. Interacts with and represents the Medical Management Department and external auditors. Responds to auditor requests and audits outcome results. Prepares and coordinates on-site and electronic audits conducted by external regulatory entities. Coordinates and ov...

Claims Operations Analyst

Healthfirst - New York, NY

Responsibilities: Data Querying and Reporting: Learn and understand Healthfirst data warehouse tables set up and successful use. Comprehend requirements of data requests. Write basic and complex data queries using SAS Enterprise Guide to generate required data sets. Review and verify data sets as necessary. Create, maintain and execute routin...

Medical Records Coordinator

Healthfirst - New York, NY

Responsibilities: Perform quality checks to maintain the integrity of events and criteria for reporting purposes. Process members' electronic documents proof data for inaccuracies or missing information. Resolve discrepancies identified using standard procedures and/or returning incomplete documents to their respective departments for correction and resolution. R...

Care Manager, UtilizationManagement

Healthfirst - New York, NY

Responsibilities: Evaluates and authorizes request for personal care services, specialty care, home care, Durable Medical Equipment (DME), outpatient rehab and transportation services from network and out-of-network providers in accordance with departmental guidelines. Collaborates directly with the medical team related to member's plan of care. Evaluates available clinical data,...

Director, BT Lead - Portfolio Management

Healthfirst - New York, NY

Responsibilities: Ensures alignment and value realization to the enterprise Drives Change Management Develop and maintain portfolio level views of the programs in the portfolio, including approach, budgets, milestones, and cross functional dependencies Works to resolves gaps/portfolio level risks Plays a primary role in Portfolio Planning from the top dow...

Primary Care Manager (RN)

Healthfirst - New York, NY

Responsibilities: Completes initial screening and clinical authorization in CareEnhance Clinical Management Software (CCMS) Creates care plans and quarterly care plan notes in CCMS Collaborates with provider doctors, Certified Home Health Care Agencies (CHHCA) and other service providers Assesses skilled service needs for new members Follows up on calls tr...

Nurse Care Manager, RN, Complete Care

Healthfirst - United States of America

Responsibilities: Contributes to the development of patient-focused care and initiates the process in accordance with established guidelines. Conducts assessments, develops treatment plans, performs defined interventions, and generates referrals to providers, community-based resources and appropriate social services. Assesses member's physical, psychosocial and discharge...

Care Manager, UtilizationManagement

Healthfirst - New York, NY

Responsibilities: Evaluates and authorizes request for personal care services, specialty care, home care, Durable Medical Equipment (DME), outpatient rehab and transportation services from network and out-of-network providers in accordance with departmental guidelines. Collaborates directly with the medical team related to member's plan of care. Evaluates available clinical data,...

Director, Facilitated Enrollment

Healthfirst - New York, NY

Responsibilities: Directs the sales and retention efforts of the FE RS staff for a specific geographic area. Directors oversee, in his or her assigned region, all hospitals, community physicians, community based organizations, schools, faith base organizations and small business that would be provide partnerships and referrals that will lead to enrollments and retention of ...

Care Manager, Utilization Management, RN or LPN

Healthfirst - United States of America

Responsibilities: Performs preadmission, concurrent, and retrospective reviews to evaluate appropriateness of admission, need for continued stay, length of stay, utilization of resources, patient outcomes, and usage of other services post-encounter. Responsible for compliance, in practice, with regulatory mandates. Identifies opportunities for and facilitates member transfer to...