Browse current Healthfirst openings that JobDrop found directly from the company's careers source.
The Grievance Specialist is a member of the Appeals & Grievances (A&G) team at Healthfirst and is responsible for managing and resolving member or authorized representative–initiated grievances and complaints across Healthfirst’s product lines, including Medicare, Medicaid, Child Health Plus (CHPlus), Senior Health Par
The Appeals & Grievances (A&G) unit processes member and non-contracted provider appeals for all of HF’s line of businesses which include commercial, Medicaid, dual enrollments, Medicare and complete care. Appeals Specialist is the subject matter expert responsible for non-clinical case development and case resolution
The Process Manager for Enrollment and Billing (E&B) leads the execution of processes that support the delivery of critical health services for Healthfirst customers. The incumbent monitors, reports, and plans for improvement across a set of core operational processes. The process manager oversees and optimizes the dai
The Fleet Driver is responsible for maintaining an efficient, well organized community outreach vehicle (COV) and cargo van at the assigned Healthfirst marketing location. The Driver is accountable for the day to day operations on the assigned COV/cargo van, liable for all marketing materials on the assigned RV, the or
The AI Infrastructure Architect role at Healthfirst works to establish sustainable design principles across infrastructure systems, cloud platforms, enterprise integration patterns, and emerging AI platform capabilities. This person will work internally across Infrastructure & Operations (I&O), as well as externally wi
The Clinical UM Pharmacist is a dynamic position responsible for the review of prior authorizations for medications requested under the medical benefit. Additionally, the Clinical UM Pharmacist is responsible for developing clinical criteria, medical policies for provider administered medications, review of monthly rep
The Senior Manager of Product Management and Strategy is responsible for working cross functionally to develop, assist in execution, and continuously improve upon a market growth strategy that supports a profitable growth across the entire Medicaid/Medicare portfolio. - Support developing presentations for on-going man
The Senior Instructional Designer is responsible for the design and development of holistic, multi-modal best-in-class programs that align to the Healthfirst culture with an emphasis in digital transformation. The Sr. Instructional Designer will focus on leading efforts to apply design standards, learning methodologies
The Senior Manager, Clinical Utilization Management (UM) Operations provides strategic and operational leadership for UM activities, with a key focus on advancing UM modernization and transformation. This role partners closely with the Vice President, internal UM leadership, external consultants, and project management
Position Summary: The Manager of Utilization Management provides daily oversight for Case Management teams (which includes RN’s, Social Workers, and Coordinators). The Manager of Utilization Management is responsible for ensuring high quality, cost-effective, and appropriate allocation of member services, treatments, a
Under the direction of the Manager of Ancillary Services, the Ancillary Services Contractor develops and maintains an Ancillary provider network that ensures Healthfirst members have superior access to the highest quality by focusing efforts on lowering claims costs, improving the quality of care, and increasing member
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic infor
We are seeking a Cyber Security Engineer – Data Security to design, implement, and continuously improve security capabilities that protect sensitive data across the enterprise. This is a hands-on security engineering role focused on understanding where sensitive data resides, how it moves, who and what can access it, a
The Appeals & Grievances (A&G) Weekend Inventory Manager is responsible for managing and monitoring appeal inventory for a team of A&G Clinical Specialist. This is a full-time role, expected to work 4 days a week and must be able to work the weekends (i.e. Fri-Mon or Thurs-Sun). The incumbent works closely with multipl
The Field Service Agent acts as an in-person liaison between Healthfirst and its customers. This individual receives and addresses member & provider inquiries, de-escalates and resolves complaints, educates clients, engages in member retention activities, and escalates issues requiring additional intervention across al
The Claims Program – Data Manager / Product Owner is responsible for the delivery of Healthfirst’s data platforms and solutions by leading day-to-day execution for a defined set of data applications, products, pipelines, or platform capabilities. This role partners with product owners, architects, governance, and busin
The Hospital Specialist is the point person responsible for ensuring maximization of operational efficiency between Healthfirst and our network hospitals. This role is required to report onsite to our 100 Church Street office Tuesday-Thursday. Responsibilities: - Managing day to day operational issues and concerns from
The Senior Business Analyst- Provider Data Operations (PDO) is responsible for business process review, data analysis and reporting as it relates to activities which ensure operational effectiveness. Incumbents assist management by coordinating workflow and working directly with more junior analysts, analyzing data, cr
Care Coordinators are responsible for performing care management services in order to support members who require assistance in navigating their health care system. The Care Coordinator supports various teams to provide excellent customer service to our NorthStar Members. Duties and Responsibilities: - Receive incoming
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. A&G works in collaboration with divisions within and outside the organiza
As a Software Production Support Lead, you will ensure the stability, availability, and performance of our products. You will collaborate with cross-functional teams to investigate complex technical issues, support users, and contribute to the continuous improvement of our processes. Duties & Responsibilities: - Review
The Entitlement Advocate provides Healthfirst’s Medicare Advantage Plan(MAP), Managed Long-Term Care Plan(LTC), Dual eligible Medicare Plan and Nursing Home members and prospects with obtaining and retaining of financial entitlements for which they are eligible. This enables prospects and members to maintain the highes
The Clinical Quality Specialist is responsible for performing Healthcare Effectiveness Data and Information Set (HEDIS) medical record review, supplemental data validation, data abstraction, and clinical data quality activities using internal and external clinical data sources. This role supports the accurate, timely,
The Manager, Medicare Digital Growth and Lead Management — Digital Sales Growth & Enterprise Lead Management - will help establish, grow, and optimize Healthfirst’s Medicare Digital sales channel while advancing enterprise lead management strategy across Medicare distribution channels. The Manager will be responsible f
The Manager, Total Cost of Care, will monitor financial performance and provide analytic insights into all products offered within the Healthfirst portfolio. This leader will serve as healthcare economics and analytics subject matter expert, across all areas of medical trend, medical cost savings, provider network info
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic infor
This role is responsible for stabilizing, designing, and evolving Healthfirst’s HR technology ecosystem so it operates as an integrated, reliable, and scalable foundation for HR service delivery and workforce decision-making. The position owns end-to-end integration design, system interoperability, and data flow across
The Senior Manager, Clinical Appeals & Grievances provides strategic and operational leadership for the Clinical Appeals & Grievances function, ensuring timely, high-quality, and compliant review of clinical appeals and/or grievance cases. This role oversees day-to-day operations, leads internal teams, and partners wit
The Sr AI Security Engineer continuously monitors the vulnerability of the enterprise and develops engineering solutions to improve the security of the Healthfirst infrastructure. The Sr AI Security Engineer applies expertise across the Cyber Security discipline by demonstrating competency in IT Infrastructure and Appl
Job Profile Summary The Support Coordinator is responsible for assisting the care/case managers with non-clinical activities such as creating cases and events; managing authorizations; providing telephonic outreach to members, providers and community-based organizations; handling member mailings; faxing clinical reques
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic infor
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. A&G works in collaboration with divisions within and outside the organiza
The Field Service Agent acts as an in-person liaison between Healthfirst and its customers. This individual receives and addresses member & provider inquiries, de-escalates and resolves complaints, educates clients, engages in member retention activities, and escalates issues requiring additional intervention across al
The Senior Provider Network Contractor is a highly specialized negotiator responsible for strategically engaging out-of-network healthcare providers and facilities to secure in-network participation at competitive, market-aligned rates for a health plan. This role is focused on high-impact, complex negotiations intende
The Field Service Agent acts as an in-person liaison between Healthfirst and its customers. The individual is responsible for assisting customers with issues and inquiries they may have about their insurance, applications and/or claims not paid. The Field Service Agent is also responsible for receiving and addressing m
The Workforce Enablement Senior Forecast Planning Analyst is responsible for leading forecasting quality, capacity planning, and performance oversight across a multichannel contact center environment, including internal operations and Business Process Outsourcing (BPO) partners. This role ensures the accuracy, consiste
Community Relations Specialists are on the front lines of improving the lives of New Yorkers by connecting people to health-insurance products and resources that create greater health equity. Community Relations Specialists are bridge-builders, connecting communities to needed information that empowers them to live hea
The Manager, Clinical Appeals & Grievances is responsible for leading, operating, and advising a dynamic and fast-paced Clinical Appeals & Grievances team. This role works closely with multiple leaders in the organization to identify priority focus areas for Appeals & Grievances, to standardize and optimize processes,
The Field Service Agent acts as an in-person liaison between Healthfirst and its customers. This individual receives and addresses member & provider inquiries, de-escalates and resolves complaints, educates clients, engages in member retention activities, and escalates issues requiring additional intervention across al
The Senior Analyst, Audit and Compliance Analytics leverages healthcare data, analytical tools, and business knowledge to support Internal Audit, Compliance Analytics, and Claims Configuration Audit initiatives. This role partners with cross-functional teams to identify risks, evaluate controls, analyze claims and conf
The Assistant Vice President (AVP) of Provider Payment partners with senior leadership to design and implement the methods and procedures essential for successful claim & benefit configuration, provider onboarding, and maintenance of provider records. The incumbent provides strategic leadership and oversight to establi
The Configuration Analyst of Office365 is responsible for managing, administering and governing the Office 365 global tenants, including SharePoint Online, MS Teams, OneDrive and other applications within the Office365 suite. The resource will work in a dedicated team focused on enterprise collaboration. Candidate must
As a valued member of the Behavioral Health Care Management Team, the Peer Support Specialist (PSS) utilizes lived experience to model recovery and support Healthfirst members who are struggling with mental health and/or substance use disorders. The PSS works directly with members in both field-based settings and telep
Healthfirst is New York City’s largest not-for-profit health insurer, dedicated to improving health through community-driven, value-based care. For over 30 years, we have led the shift from volume to value by focusing on better outcomes, preventative care, and cost efficiency. Recognized by Forbes as a Dream Employer o
The Director Enterprise Delivery Services, in support of their assigned strategic focus area develops, implements, and executes strategies to deliver on the Healthfirst strategic plan. This person has the responsibility to educate the company, suppliers and other invested parties on all technology, process and organiza
The Director Enterprise Delivery Services, in support of their assigned strategic focus area develops, implements, and executes strategies to deliver on the Healthfirst strategic plan. This person has the responsibility to educate the company, suppliers and other invested parties on all technology, process and organiza
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic infor
The Senior Mgr of Clinical Eligibility will have knowledge of the current assessment process, for both Medicaid and Medicare programs. This position will support the Assessment Managers in planning, directing, and implementing processes for successful outcomes and achieving goals. The Sr Mgr conducts and contributes to
Healthfirst is New York City’s largest not-for-profit health insurer, dedicated to improving health through community-driven, value-based care. For over 30 years, we have led the shift from volume to value by focusing on better outcomes, preventative care, and cost efficiency. Recognized by Forbes as a Dream Employer o
The Vendor Partner Specialist is the principal contact for all vendor-related interdepartmental collaborations and is responsible for the relationship and management of business services being performed by external vendors (including off-shore). Management of these services will include, but not be limited to, service
The Field Service Agent acts as an in-person liaison between Healthfirst and its customers. This individual receives and addresses member & provider inquiries, de-escalates and resolves complaints, educates clients, engages in member retention activities, and escalates issues requiring additional intervention across al
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic infor
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic infor
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic infor
The Senior Analyst, Total Cost of Care, will develop analyses and tools to help monitor financial performance and provide analytic insights into all products offered within the Healthfirst portfolio. This key role will serve as healthcare analytics and data subject matter expert, supporting all areas of medical trend,
The Claims and Provider Payment Modernization Manager represents Healthfirst Operations in the support of defined claims-related and/or provider payment modernization efforts. S/he will have business oversight of capabilities as they transition from legacy models and systems into new standard configurations and new sys
The Clinical Pharmacist is responsible for efforts to support quality measures for both our Essential Plan and Medicare populations. The Clinical Pharmacist conducts provider and member outreach to address gaps in care measures, support medication adherence initiatives, and assist with strategies to improve quality mea
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic infor
The UM Pharmacy Technician is responsible for the intake and review of prior authorization requests for medications requested under the medical benefit. The UM Pharmacy Technician makes approval decisions and denial recommendations based on predetermined clinical criteria. They establish rapport with Provider offices a
Healthfirst is New York City’s largest not-for-profit health insurer, dedicated to improving health through community-driven, value-based care. For over 30 years, we have led the shift from volume to value by focusing on better outcomes, preventative care, and cost efficiency. Recognized by Forbes as a Dream Employer o