Browse current Healthfirst openings that JobDrop found directly from the company's careers source.
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 Learning Delivery Specialist will act as an ambassador in fostering the HF culture and supporting the implementation and delivery of content relevant to enterprise initiatives, business units and strategy. This individual will lead and support learning projects and will be responsible for researching, designing, de
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 Service Agent is responsible for supporting Contact Center Operations (CCO) by ensuring members and/or providers receive an exceptional customer experience. This individual receives and addresses member & provider inquiries, resolves complaints, educates clients, retains members, helps to prevent dis-enrollments, a
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
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 Healthcare Analyst (HCA) provides support through the research and investigation of business issues related to cost, utilization, and revenue data for multiple Healthfirst products. The HCA will identify/monitor cost and utilization trends and the root causes in health plan trend performance and provide recommendat
The Relationship Coordinator solicits and provides information via telephonic efforts in support of Healthfirst's Medicare Advantage Plan, Complete Care (MAP), Managed Long Term Care Plan (MLTC) Senior Health Partners (SHP) and Mainstream/Health and Recovery Plan (HARP) population seeking PCA and/or CDPAS services. Thi
The Bilingual (Spanish and/or Man/Can) Sr Retention Advocate (SRA) is responsible for educating and providing Healthfirst members support to obtain financial entitlements for which they are eligible that enable members to maintain the highest level of independence both at home and within their communities. The SRA prov
The Field Based Care Manager evaluates members’ care needs and promotes quality outcomes and treatment via a variety of modalities and engagement strategies. The Field Based Care Manager works directly with members in field-based settings and telephonically to support members’ unique care needs and successful engagemen
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 Senior HR Shared Services Specialist is responsible for resolving complex, high impact inquiries and transactions across multiple tiers within the HR Shared Services (HRSS) organization. Serving as a subject matter expert (SME) this role is accountable for the governance and continuous improvement of the HRSS Servi
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
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 Community Office Specialist is the primary interface and front line resource for the community office. S/he will triage, research, educate, liaise and manage the community office efficiency, while tracking and providing metrics on office production. S/he works in tandem with the Manager on processes, procedures and
The Medicare Outside Sales Representative is a top performing membership growth agent responsible for identifying, educating prospective Medicare Advantage (MA) beneficiaries in the appropriate MA plan based on prospect’s needs and qualifications. The Outside Sales Rep explains program benefits in a manner that is comp
In partnership with the Enterprise Delivery teams, the Information Owner is responsible for aligning the Customer Experience with the enterprise information architecture and corporate strategy. This role collaborates with enterprise and solution architects, business process owners (BPO), and subject matter experts (SME
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
As key position under Enterprise Correspondence, this role will be responsible for developing and leading the architecture, design, and implementation of enterprise content management solutions built on the Alfresco platform. This role requires a strong combination of solution architecture expertise and hands-on techni
The Clinical Quality Manager with members and providers to ensure members receive appropriate services. This role emphasizes improving the quality of care with a focus on HEDIS, QARR and Medicare Advantage Star measures. - Interacts with hospitals, providers, and members to improve quality of care, monitor progress, an
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 Quality Data Validation & Governance provides strategic and operational leadership for HEDIS clinical data validation, supplemental data governance, and quality reporting activities. This role is responsible for ensuring the accuracy, integrity, compliance, and audit readiness of clinical data use
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
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 Entitlement Advocate provides Healthfirst 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 highest
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 Associate of Strategic Account Management is a pivotal role responsible for a wide range of tasks to ensure that each Strategic Account Management team is aligned and delivers results. The Strategic Account Management Associate has responsibility for tracking and communicating daily, weekly, and monthly activities
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
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
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
The MarketPlace Facilitated Enroller is responsible for identifying and educating potential members on all aspects of the plan including new Medicaid, CHP/EP/QHP and answering questions regarding plan’s features and benefits. Responsible for identifying and assisting current members who are due to recertify their healt
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
Position Summary: The Appeals & Grievances Clinical Specialist is responsible for receiving, investigating and responding verbally and in writing to member and provider clinical appeals and grievances. Duties and Responsibilities: - Ensures that appeals and grievances are properly classified (e.g. denial of service, de
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 Sr Project Manager Clinical Transformation (Sr PM) uses their deep knowledge of clinical operations business processes, regulations, and technology to lead large-scale, complex initiatives focused on the implementation of Utilization Management (UM), Care Management (CM), and related clinical operations platforms a
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 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 Team Lead, Enrollment & Billing is responsible for overseeing production for a defined line of business at Healthfirst. The Team Lead, Enrollment & Billing is directly responsible for supervising non-exempt employees, monitoring attendance, approving time cards of the staff and providing production reports to manag
The HR Business Partners are the culture architects for the organization and responsible for delivering human capital solutions that enable the success of our business. The Senior Manager, HRBP-IT leads and manages the full suite of talent lifecycle activity by partnering with business leaders to deliver solutions deve
The Product Owner for Provider Data Operations will help create and deliver a best-in-class business systems and operational processes. This individual will be dedicated to the Agile Work Team to interface between the operations team and the delivery of new technology and code. The role is responsible to be constantly
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 Project Manager Clinical Transformation (PM) supports the end-to-end coordination and execution of cross-functional initiatives focused on clinical operations enablement, workflow modernization, regulatory readiness, operational adoption, and technology implementation across Healthfirst. The PM is responsible for c
The Mgr Medicaid Growth & Retention’s primary focus will be to work cross functionally to develop, execute, support, and continuously improve on strategies and operations related to retention, growth, and financial performance that contribute to profitable growth in the PHSP product portfolio. This role is also respons
The Lead Enterprise Process Architect is a member of the Enterprise Architecture team responsible for defining and governing the enterprise process architecture framework that enables effective collaboration between people, AI agents, automation capabilities, and enterprise systems. This role establishes the methodolog
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 Production Support Manager is responsible for the stability, reliability, and support of enterprise data platforms and production data assets. This role leads production support activities, coordinates incident resolution, drives root cause analysis, and partners with engineering, infrastructure, architecture, and
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 Product Owner will help create and deliver a best-in-class business systems and operational processes. This individual will be dedicated to the Agile Work Team to interface between the operations team and the delivery of new technology and code. The role is responsible to be constantly thinking through the processe
The Director of Utilization Management is a transformational clinical operations leader responsible for delivering strategic and operational oversight for Utilization Management (UM) teams. This high-impact forward-thinking leader drives clinical and operational excellence across all UM functions, including prior autho
The Director of Configuration, Benefit Administration is responsible for design, implementation, and deployment of benefit configuration structure in order to support product and regulatory needs. This role implements the configuration structure within Healthfirst’s technology platforms to administer benefits taking in
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