Jobs at Healthfirst - Page 4

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Displaying results 46 - 60 of 97

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...

Business Relationship Manager

Healthfirst - New York, NY

Responsibilities: Develop and manage the relationship between IT and internal and external partners (business units, IT Solutions/Service Delivery teams) to drive customer satisfaction for assigned Business unit. Accountable for overseeing all IT services to the customer and supports focusing these services to the critical business needs. For identified problems and issue...

Manager, Human Resources Business Partner

Healthfirst - New York, NY

Responsibilities: Duties 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. ...

Product Management Associate- Medicaid

Healthfirst - New York, NY

Responsibilities: Monitors policies/processes and achieves product deliverables Collaborates with various departments to ensure we are pro-actively troubleshooting issues and resolving them in a timely manner. Answers questions, conducts research and tracks/resolves any member inquiries assigned to this position. Routinely checks/audits all member corresponden...

Risk Adjustment Reporting Analyst

Healthfirst - New York, NY

Responsibilities: Effectively track and monitor programs and communicate expectations with team members and other stakeholders as well as identify issues and make recommendations. Create, maintain and optimize SAS programs to perform risk adjustment data analysis to monitor performance of retrospective and prospective risk adjustment programs, as well as gather data and conduct...

Operations Analyst

Healthfirst - Lake Mary, FL

Responsibilities: Analyzes and reports on developments and changes that have been reported. Ensures issue description is accurate and actionable by engaging users for more information where necessary. Generates, adjusts and maintains existing business analytic reports using SQL and/or MS Access. Supports simple ad-hoc reporting requests from the business unit leadership ...

Field Reassessment Nurse, RN

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...

Driver

Healthfirst - New York, NY

Responsibilities: Maintains a clean and organized COV/cargo van on a daily basis. Checks the interior and exterior of the vehicle for cosmetic and operational concerns. For example, checking for loose cabinet handles, hanging wall paper, torn rugs/ floors, dents and cracks, broken glass and rest room malfunctions. Performs minor maintenance tasks on the vehicle when necessary, this will...

Business Analyst, Network Management

Healthfirst - New York, NY

Responsibilities: Perform assessments and validations of system fee schedules, contracts, and provider setup and/or configuration. Responsible for researching, creating ad-hoc requests and conducts analysis that includes but not limited to claims, financial spend and utilization reports. Research, compile, verify, interpret, analyze and create dashboards; identify trends...

Intake Nurse, RN (Car Required)

Healthfirst - New York, NY

Responsibilities: Conducts enrollment assessments of prospective members in their homes; makes enrollment decisions and develops initial plans of care by utilizing clinical expertise and critical thinking skills. As needed, will conduct assessments in settings other than home as needed, e.g. skilled nursing facilities Determines clinical eligibility of prospective members follo...

Intake Nurse RN-bilingual (car required)

Healthfirst - New York, NY

Responsibilities: Conducts enrollment assessments of prospective members in their homes; makes enrollment decisions and develops initial plans of care by utilizing clinical expertise and critical thinking skills. As needed, will conduct assessments in settings other than home as needed, e.g. skilled nursing facilities Determines clinical eligibility of prospective members follo...

Healthcare Interpreter - Bilingual Russian

Healthfirst - New York, NY

Responsibilities: Translation services: Support the Healthfirst staff by interpreting the staff-to-member and member-to-staff conversation. Facilitate cross-cultural communication within allotted time for staff member and client Provide Care Management support to members and their families. Respond to member questions and resolve minor problems as directed. Remain accessible and...

Manager, Commercial Product Operations

Healthfirst - New York, NY

Responsibilities: Manages all work relative to identifying, analyzing and developing product related project plans to increase productivity, quality, cost effectiveness, timeliness of operations, and customer satisfaction. Manages the assessment of key market factors, including competitive landscape, consumer insights and unmet customer needs as input to develop new plan designs...