Healthfirst - Remote work

Seeking an experienced **Application Developer/Manager** to lead the **Digital Provider Collaboration Program** in the **United States**. This role requires deep expertise in **Qlik Sense**, **Qlik Cloud**, and **NPrinting** to design complex healthcare dashboards and reports. You will guide agil...

Regulatory Specialist needed to ensure compliance with CMS and NY DOH regulations in Utilization Management, Care Management, and Appeals. Requires a High School Diploma, 4+ years of healthcare experience, and strong knowledge of managed care compliance. Based in the US, this role offers medical,...

Bilingual Sales Operations Service Agent needed to deliver exceptional support to brokers and agents across the U.S. Leverage your Spanish, Mandarin, or Cantonese skills to handle phone, email, and chat inquiries regarding eligibility, claims, and commissions. We seek candidates with telephonic c...

Join Healthfirst as a Medicare Sales Support Associate to drive community enrollment and membership growth. This role requires 75% travel and experience in sales, marketing, or community outreach. You will coordinate events, build partnerships with community organizations, and support Medicare Sa...

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...