Healthfirst - United States, Remote work

Seeking a detail-oriented **Healthcare Operations Analyst** to join our Optimization Team in the **United States**. You will analyze **provider data** workflows, perform reconciliation across systems, and implement scalable solutions to enhance operational performance. Requires advanced **Excel**...

Bilingual CCO Service Agent needed in New York to deliver exceptional customer experiences in a fast-paced healthcare contact center. You will resolve member and provider inquiries, meet KPIs, and drive improvements. Requires a High School Diploma and customer service experience. Benefits include...

Join Healthfirst as a CCO Service Agent in New York, delivering exceptional customer service to members and providers across all lines of business. You’ll handle inquiries, resolve complaints, and meet KPIs in a fast-paced, omnichannel contact center environment. Requires a High School Diploma an...

Senior Regulatory Specialist – Pharmacy role ensuring CMS and DOH compliance. Monitor regulations, support implementation, and act as liaison between Pharmacy and Regulatory Affairs. Requires knowledge of state/federal requirements and High School Diploma. Bachelor’s, managed care, or pharmacy ex...

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...

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...

Join Healthfirst as a Senior Credentialing Specialist, ensuring provider and facility compliance with NYS and CMS regulations. Utilize your 5+ years of credentialing experience, including facilities knowledge, to perform primary source verifications and audit files. This role offers comprehensive...

Lead the design of cutting-edge agentic AI systems as an Enterprise AI Architect. You will define architectural runways for AI initiatives, specializing in multi-agent orchestration and MCP-based integrations. This role requires deep expertise in AI/ML frameworks and cloud platforms, plus experie...

Join Healthfirst as a Clinical Pharmacy Tech. You will serve as a Pharmacy Navigator, reviewing medication lists and collaborating with teams to improve adherence and prevent adverse events. This role requires a certified/registered Pharmacy Technician with strong communication skills. We offer c...

Join Healthfirst as a Clinical Pharmacy Tech and serve as a vital Pharmacy Navigator for members. You will ensure medication adherence, minimize therapy gaps, and collaborate with pharmacists and providers. This role requires national certification/registration and offers comprehensive benefits i...

Seeking a licensed Clinical UM Pharmacist to review prior authorizations for medical benefit medications. You will develop clinical criteria, ensure CMS/NYSDOH compliance, and collaborate with physicians. This remote US role requires pharmacy review experience and offers full medical, dental, and...