Healthfirst

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 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...

Seeking a licensed Broker Account Manager in New York to support and grow our Medicare distribution partnerships. You will manage key relationships, ensure operational excellence, and resolve service issues to drive compliant growth. This role requires strong account management skills, Medicare k...

Gain hands-on clinical experience in a 10-week paid summer internship for nursing students. Support Medicare/Medicaid members through outreach, care coordination, and education in downstate New York. This immersive program develops leadership skills while contributing to population health and hea...

Lead pharmacy benefit strategy and compliance for a major health plan. 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 benefits. We offer comprehensive medical, dental, vision, and 401k benefits.

Lead data engineering initiatives to enhance provider analytics at Healthfirst. This senior role requires AWS cloud expertise and proficiency in Python, Java, or C# for building ML-driven data products. You will develop tools that improve member health outcomes and operational efficiency. We offe...

Join Healthfirst as a Senior Salesforce Developer in a hybrid role based in New York City. You will design and deliver enterprise solutions using Salesforce Lightning, APEX, LWC, and Field Service Lightning. This role requires 5+ years of experience architecting systems and implementing Sales & C...

Join Healthfirst as a Field Service Agent in Manhattan. Be the vital in-person liaison, resolving complex customer inquiries and ensuring an exceptional experience. This role requires strong conflict resolution skills in a fast-paced, multi-channel environment. We offer comprehensive benefits inc...

Field Assessment RN needed in Bronx, NY to conduct home and virtual assessments for Healthfirst’s long-term care plans. Requires an active NYS RN license, strong tech proficiency (UAS, EHR), and travel across downstate New York. Enjoy a $10,000 Sign-On Bonus, comprehensive benefits, and 401k. Joi...

Lead and optimize a dynamic Appeals & Grievances team at Healthfirst in New York or Lake Mary. This role requires expertise in compliance, process standardization, and team management within a fast-paced healthcare environment. Drive performance, quality, and strategic growth while collaborating ...