Healthfirst

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**...

Senior Project Manager sought to lead large-scale enterprise transformation initiatives at Healthfirst in New York. This role demands expertise in managing complex projects with operational and technology dependencies within healthcare or regulated environments. Key responsibilities include drivi...

Growth Relationship Manager, MLTC/MAP sought in New York to manage top-tier Licensed Home Care Agencies and drive referrals for Integrated Products. Requires bilingual fluency (Mandarin, Cantonese, Spanish, etc.), Medicaid/MLTC knowledge, and travel. Build provider networks, resolve complex issue...

Join Healthfirst, NYC’s top not-for-profit insurer, as a Field Assessment Registered Nurse. Conduct home and virtual assessments using the UAS system for members in the Bronx and downstate NY. We seek an RN with a NY license, tech proficiency, and strong critical thinking skills. Enjoy a flexible...

Seeking an RN, LPN, or Dental Hygienist for an Appeals & Grievances Clinical Specialist role in New York City or Lake Mary. Manage clinical case development and resolution for member complaints, ensuring compliance with NYS and Medicare regulations. Requires experience in utilization review, case...

Healthfirst seeks a Provider Network Account Manager in New York to drive provider engagement strategies focused on quality, clinical efficiency, and population health. You will serve as a liaison for physician groups, manage recruitment, resolve issues, and monitor performance. Ideal candidates ...

Join Healthfirst as a Broker Sales Support Associate in New York. Drive membership growth through community marketing, events, and strategic partnerships. Requires 75% travel, sales experience, and strong communication skills. Enjoy medical, dental, vision coverage, 401k, and incentive programs.

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...

Director of Utilization Management sought to lead clinical operations in New York, driving excellence in prior authorizations, concurrent reviews, and service requests. This role requires deep healthcare leadership experience with Medicare, Medicaid, and MLTCP, plus expertise in CMS and NYSDOH co...

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...