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Keeping New Yorkers Healthy

At Healthfirst, we offer comprehensive care services to our members in the community. We aim to keep our members safe, healthy, and provide attentive care. We have many opportunities available in different clinical specialties.

Caring for Our Members

Yanira visits members to evaluate what types of care and which services they’ll need to safely manage their health at home. She also teaches members and their families about disease management so that they can proactively maintain and improve their health. Interested in joining our Nursing and Clinical Operations team? Check out our available positions listed below.

Open Positions in Nursing and Clinical

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A&G Clinical Specialist

Lake Mary, FL Req ID: R016503 Remote Clinical Services
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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Assessment Nurse

New York, NY Req ID: R018751 Hybrid Clinical Services
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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Clinical Director

Req ID: R019818 Remote Clinical Services
Duties/Responsibilities:Examines provider claims and service authorizations for completeness, accuracy, and medical necessity and proposes resolutions per internal and regulatory processes.Communicates to relevant teams and providers any claims/ authorization inaccuracies found along with...
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Director, Clincial

Home Office, CT Req ID: R018723 Hybrid Clinical Services
Designs, implements, and evaluates clinical initiatives and programs, in collaboration with key stakeholders, to improve access, clinical quality and medical cost management. Promotes a culture of shared learning and continuous quality improvementParticipates actively in strategic planning for BH...
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LG - Remote Assessment Nurse Test Req

New York, NY Req ID: R016400 Hybrid Clinical Services
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 needed,...
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LG - Remote Care Coordinator Test Req

Home Office, NY Req ID: R016414 Remote Clinical Services
Duties and Responsibilities: Receive incoming calls from members regarding benefit questions/issues, care coordination, program inquiries, connecting to their care manager, and screening assessments to identify risk factors requiring medical intervention Contemporaneously and accurately...
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LG Support Coordinator Test Req

New York, NY Req ID: R016466 Remote Clinical Services
- Handles calls to and from members to assist with benefit questions/issues, schedule appointments, and screen assessments to identify risk factors which need closer intervention. - Handles calls to and from providers regarding authorizations, referrals, visits, tests, and faxed care plans. -...
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Path 29 (00336 Paydoc Program)

New York, NY Req ID: R016112 Hybrid Clinical Services
Duties/Responsibilities: Works with the AVP of Pharmacy Benefits and the Clinical Pharmacy Director to design and manage the Healthfirst Pharmacy Benefit for all Medicare plans. Strategically leads the development, planning and implementation of the annual pharmacy benefit cycle to ensure that...
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Pharmacy Technician

Home Office, TX Req ID: R016064 Remote Clinical Services
Duties & Responsibilities: Performs review of medication lists to understand and eliminate barriers to medication therapy while serving as the member's Pharmacy Navigator in order to achieve the following:Proper Medication Adherence Minimize any gaps in therapy Prevention of medication related...
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PT - Email Reminder

New York, NY Req ID: R016348 Remote Clinical Services
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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Test Auto Reminde Email - Clinical

New York, NY Req ID: R016343 Remote Clinical Services
Duties and Responsibilities: Tracks, trends, and proactively identifies issues with various data feeds  Conducts ad-hoc analysis pertaining to member care quality Supports others in Clinical Quality and interdepartmental strategies and projects Performs quality assurance for various...
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Test MEDPRWFT

Field Office, NY Req ID: R016616 Remote Clinical Services
Duties/responsibilities: ·       The Medical Director will assess/review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations. ·       The Medical Director will render...
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UM Support Coordinator - 100% Remote

Home Office, NY Req ID: R017270 Remote Clinical Services
- Handles calls to and from members to assist with benefit questions/issues, schedule appointments, and screen assessments to identify risk factors which need closer intervention. - Handles calls to and from providers regarding authorizations, referrals, visits, tests, and faxed care plans. -...
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