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A&G Clinical Specialist

FL Req ID: R016503 Remote
Duties and Responsibilities: Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of services. The end to end process requires the...
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Application Developer

NY Req ID: R019941 Remote
• Designs, develops, and maintains complex applications• Develops unit tests and provides code coverage to accurately test business logic and functionality• Participates in developing specifications such as user stories and designs• Solves or recommends solutions for complex issues and problems•...
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Application Developer

NY Req ID: R019953 Remote
• Designs, develops, and maintains complex applications• Develops unit tests and provides code coverage to accurately test business logic and functionality• Participates in developing specifications such as user stories and designs• Solves or recommends solutions for complex issues and problems•...
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Assessment Nurse

NY Req ID: R019905 Hybrid
Duties and Responsibilities: Conducts home assessments (and virtual assessments, as needed) for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and...
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Assessment Nurse

NY Req ID: R018751 Hybrid
Duties and Responsibilities: Conducts home assessments for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills.  As...
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Assessment Nurse

NY Req ID: R019966 Hybrid
Duties and Responsibilities: Conducts home assessments for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills.  As...
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Assessment Nurse-2

NY Req ID: R019963 Hybrid
Duties and Responsibilities: ·        Conducts home assessments for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills.  As...
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Avature Test - Manager

NY Req ID: R016450 Remote
Partners with Director of Benefits in support of the company’s employee benefit, recognition, and retirement program strategy and administration, including open enrollment Conducts benefits analyses, researches benefits practices, and operationalizes programs to improve employee health, wellness,...
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Budget Analyst

CT Req ID: R018721 Hybrid
Lead annual operating plan and quarterly forecast process.Partner with business leaders to meet the operational budget requirements for area of responsibility.Review and monitor staff work providing training, evaluation and direction.Perform review and analysis of membership, headcount, and...
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Business Analyst

NY Req ID: R018765 Hybrid
Duties & Responsibilities:Review, analyze and create all General Ledger (GL)reports monthly (e.g., Revenue, AFDA; Write offs).Support the AR balance by compiling the details of all DENY/PEND/Unprocessed and Rate Change reports. Support and report AR sub-ledger aging and collections.System...
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Business Analyst Testing NQ

NY Req ID: R019992 Hybrid
Develop and maintain new and existing reporting tools, databases, and processesAnalyze various types of data and processes in a versatile manner and professionally present findings and recommendationsQuery and manipulate data to root cause, trend, summarize findings, and offer...
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Care Manager

NY Req ID: R019949 Remote
Duties/Responsibilities:Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.Conducts assessments to identify barriers and opportunities for intervention.Develops care plans that align with the physician’s treatment plans and recommends...
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Care Manager

NY Req ID: R019944 Remote
Duties/Responsibilities:Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits.Conducts assessments to identify barriers and opportunities for intervention.Develops care plans that align with the physician’s treatment plans and recommends...
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CCO Service Agent

NY Req ID: R019906 Remote
Duties and Responsibilities Provides excellent quality customer service to our members and/or providers relating to all aspects of member/provider questions and issues such as eligibility, benefits, claims process, escalations, and product questions, etc. May include but is not limited to...
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CCO Sr Service Agent

NJ Req ID: R018700 Remote
Duties and Responsibilities ·       Provides high quality assistance to the team via phone, chat, video call, email, in person, and/or other communication channels related to servicing our members and/or providers. May include but is not limited to inbound/outbound calls/emails/chats,...
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Chief Clinical Officer

NY Req ID: R019835 Hybrid
Manages and oversees team to sets the strategy, direction, policies, and goals for Healthfirst’s Clinical departmentsInterfaces with the Board of Directors, CEO, regulators, and other medical employees on clinical and quality initiativesMakes recommendations to the CEO on medical issues related...
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