Healthfirst

Join Healthfirst as a Field Assessment RN, conducting in-home health evaluations in downstate New York. Utilize your NYS RN license and clinical skills with the Uniform Assessment System (UAS) to determine member eligibility and care plans. This field-based role requires tech proficiency and offe...

Seeking a NYS-licensed Physical Therapist for a Clinical Peer Reviewer role in Utilization Management. Utilize your 5+ years of clinical experience to review rehab service authorizations, ensuring medical necessity and regulatory compliance. This remote US position offers full benefits and focuse...

Lead our Behavioral Health Children's Services as Director, overseeing clinical operations and care management for pediatric members (0-21) in New York. This key leadership role requires a licensed BH professional with 7+ years of experience, including Medicaid managed care and work with children...

Lead pharmacy benefit strategy and compliance for a major health plan in New York. This senior role requires a PharmD and expertise in Medicare Part D, PBM oversight, and regulatory guidance. You will manage a team to design flawless pharmacy benefits. We offer comprehensive medical, dental, visi...

Lead the Medicare customer experience strategy in this hybrid New York role. Utilize your 10+ years in CX strategy and Medicare Advantage expertise to enhance member journeys. Translate insights into initiatives with cross-functional teams, driving satisfaction and loyalty. Enjoy comprehensive be...

Lead strategic performance improvement initiatives in NYC or Lake Mary. Drive measurable outcomes in clinical and operational processes using data analysis, AI, and cross-functional leadership. This senior role offers comprehensive benefits and focuses on sustainable value delivery.

Lead large-scale healthcare transformation initiatives as a Senior Project Manager at Healthfirst. You will modernize Utilization Management through AI, automation, and process redesign. This role requires expertise in complex project delivery within regulated environments. Drive operational effi...

Join Healthfirst as a Medical Peer Reviewer, ensuring medical necessity and regulatory compliance in utilization management. This vital role requires an MD/DO/DMD/DDS license and relevant board certification. You will assess authorization requests, collaborate with medical teams, and enjoy compre...

Seeking an RN, LPN, or Dental Hygienist for the role of Appeals and Grievances Clinical Specialist in NYC or Lake Mary. You will be the clinical subject matter expert, managing case resolution and ensuring regulatory compliance. This role offers medical benefits and a 401k, ideal for those skille...

Join Healthfirst as an Entitlement Advocate, supporting Medicare and Medicaid members in the New York area. You'll help secure financial entitlements through inbound/outbound calls, field visits, and electronic documentation. This hybrid role requires bilingual skills, tech proficiency, and trave...

Seeking a Network Account Manager to represent Healthfirst with FQHC providers. You will serve as the main liaison, managing relationships and resolving plan-related issues in a designated area. This role requires Medicaid/Medicare managed care experience and offers comprehensive benefits.

Lead our strategic efforts to reduce Out-of-Network spend as the Director of OON Contracting in New York. You will develop and negotiate complex facility and professional contracts, leveraging 10+ years of managed care expertise. This leadership role demands deep knowledge of reimbursement method...