Jobs at Healthfirst - Page 3

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Field Member Services Representative - Bronx - Bilingual Spanish

Healthfirst - New York, NY

Responsibilities: Assists all Healthfirst members with inquiries in regards to benefits, claim payments and Healthfirst policies and procedures. Performs Primary Care Physician and address changes for members using computer application. Investigates as well as resolves member complaints and concerns. Forwards all necessary issues to correct departments or sends issue/c...

HRBP Manager

Healthfirst - Lake Mary, FL

Responsibilities: Proactively supports and directs the delivery of all HR and Change Management strategies, initiatives and processes for a defined segment of a business. Builds a strong business relationship with leadership team and serves as a key adviser enabling strong management and leadership across the business. Facilitates the design and implementation of...

Clinical Quality Manager

Healthfirst - New York, NY

Responsibilities: Lead all assigned network hospitals and large provider groups to improve HEDIS/QARR scores and best member outcome. Monitor provider-specific HEDIS report cards. Identify areas of concern, and raise concerns with management and hospital contacts. Provide assistance with root cause analysis related member low quality scores and develop ...

Project Coordinator - EPMO

Healthfirst - New York, NY

Responsibilities Hold regular sessions with the project team to review and update tasks in the plan Coordinate between all the various department project resources to ensure deadlines are understood and met Liaise with all the employees and 3rd party resources that are involved in the project Utilize PPM Software to keep a close watch on t...

CPM Analyst

Healthfirst - New York, NY

Responsibilities: Compiles information from multiple sources to prepare and distribute time-sensitive and accurate reporting for internal and external audiences Uses Business Intelligence tools to create data extracts and reports from other department databases Conducts basic to intermediate statistical analyses Summarizes analytical findings and trends with r...

Senior Relationship Coordinator, bilingual Spanish

Healthfirst - New York, NY

Responsibilities: The Senior Relationship Coordinator will handle escalated customer complaints upon customer or executive request and utilize escalations as a method to train and develop staff working closely with management and the Quality Assurance Team. Contribute to the development and implementation of Job-Aids and Process Releases Administer new hire train...

Non-Clinical Coordinator, Appeals and Grievances (Telecommuter)

Healthfirst - United States of America

Responsibilities: Ensures appeals and grievances are categorized and processed within New York State and Federal time frames. Enters all appeals and grievances in the Unit's software tracking system. Identifies potential quality issues and initiates referrals to the Quality Improvement Department. Requests waivers from providers for non-clinical Medicare claim...

Nurse Care Manager, RN, FIDA

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 d...

ETL/Data Warehouse Developer

Healthfirst - New York, NY

Responsibilities: Understand business requirements and translate them to technical specifications. Develop SAS and Informatica mappings and workflows to meet the data migration, cleansing and integratipon needs, using Informatica Powercenter. Create data models to give best system performance. Identify and develop verification, control, cleansing, exception and e...

Senior Claims Strategist (Senior Provider Advocate)

Healthfirst - New York, NY

Responsibilities include, but are not limited to: Responsible for conducting root cause analysis and working with staff in other business areas to assist with the resolution of complex Provider issues. Achieve expected goals and outcomes within established timeframes. This includes keeping Network and Claims Management informed on progress of issues. Through resea...

Relationship Coordinator - Bilingual Spanish

Healthfirst - New York, NY

Responsibilities: Working under the direction of the Relationship Supervisor, maneuvers multiple tasks independently with a fast-paced proactive vs. reactive approach to changing priorities, call volume and telemarketing call and appointment goals.Handling of both inbound and outbound calls Attention to managing many details and remaining focused in an environment with distracti...

Reassessment Nurse Bilingual Spanish

Healthfirst - New York, NY

Responsibilities: Conducts UAS (Uniform Assessment System) for active members every six months to determine service needs and continued eligibility. Completes reassessment of service needs at the request of the Care Team, Member's Family/Caregiver to determine if service level(s) need to be adjusted. Completes Patient Review Instruments/Screens and all required nu...

Writer/Editor, Clinical Correspondence Unit - Appeals & Grievances

Healthfirst - United States of America

Responsibilities: Perform daily reviews of manual letters produced from CCMS to member and providers to ensure adherence to Article 44 and 49 of the NY State Public Health Law and Appendix F, Medicare Managed Care Manual Chapter 13 and commercial contracts and others as necessary. Ensure compliance with Healthfirst corporate branding requirements. Conduct quality checks...

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...

Director Healthcare Payment Innovation & Reimbursement Strategy

Healthfirst - New York, NY

Responsibilities: In this leadership role the individual is responsible for coordinating the execution and implementation of various innovative network management initiatives, specifically: Development and implementation of Healthfirst's value based payment strategy. Operational oversight and ROI evaluation of VBPs and Pay for Performance Agreeme...