Healthfirst - United States, New York, Health and Beauty

Seeking an RN or LPN 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 for member complaints and ensuring regulatory compliance. This role requires experience in utilization review, claims, and ...

Lead strategic clinical operations for Utilization Management at a major New York health plan. Drive excellence in prior authorization, concurrent review, and regulatory compliance for Medicare/Medicaid programs. This leadership role requires deep managed care expertise and a focus on process inn...