152 jobs

As a key member of the Behavioral Health Children's Services leadership team, the Clinical Operations Director, Children's Services, monitors the clinical functioning of the Children's Services program model and provides oversight of the Children's utilization management teams and case management te ...

The Director of DSE Strategic Programs is responsible for leading the planning and execution of key strategic projects that span across the entire Delivery System Engagement (DSE) - Provider Engagement team in pursuit of developing and maintaining an accessible quality network that supports the need ...

Position Summary: The Manager of Utilization Management provides daily oversight for Case Management teams (which includes RN's, Social Workers, and Coordinators). The Manager of Utilization Management is responsible for ensuring high quality, cost-effective, and appropriate allocation of member ser ...

The Product Owner will help create and deliver a best-in-class business systems and operational processes. This individual will be dedicated to the Agile Work Team to interface between the operations team and the delivery of new technology and code. The role is responsible to be constantly thinking ...

The Healthcare Economics Analyst (HEA) provides support to the Medical Economics team within Finance through the research and investigation of business issues related to cost, utilization and revenue data for multiple Healthfirst products. The HEA will identify/monitor cost and utilization trends an ...

The Regulatory Complaint Analyst is responsible for responding to complaints initiated by regulatory agencies, and oversees the complaint response process to facilitate timely resolutions and responses. Regulatory reporting required. Duties/Responsibilities: Records all provider and member complaint ...

The Senior Medical Economics Analyst (Sr. MEA) provides support and consultation to the Medical Economics team within Finance through analyzing key business issues related to cost, utilization and revenue for multiple Healthfirst products. As the Sr. MEA, you will design and develop reports to monit ...

Who we are: Healthfirst was founded by a collection of major healthcare systems in the New York area to emphasize high quality of care, and better patient outcomes. We have grown into New York's largest not-for-profit health insurer, and cover over 1.6 million members in New York City and on Long Is ...

The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, and case management as assigned. The Case Manager, Utilization Management is also responsible for efficient utilization of health services an ...

The Manager, Appeals & Grievances is responsible for leading, operating, and advising a dynamic and fast-paced Appeals & Grievances team. This role works closely with multiple leaders in the organization to identify priority focus areas for Appeals & Grievances, to standardize and optimize processes ...

The Director, Medicaid Product Management will drive financial performance of the Medicaid portfolio of products. This Director role will be responsible for crafting and managing product portfolio strategy, leading short and long-range planning for the business, and optimizing operational excellence ...

Under the direction of the Manager of Ancillary Services, the Ancillary Services Contractor develops and maintains an Ancillary provider network that ensures Healthfirst members have superior access to the highest quality by focusing efforts on lowering claims costs, improving the quality of care, a ...

Who we are: Healthfirst was founded by a collection of major healthcare systems in the New York area to emphasize high quality of care, and better patient outcomes. We have grown into New York's largest not-for-profit health insurer, and cover over 1.6 million members in New York City and on Long Is ...

Who we are: Healthfirst was founded by a collection of major healthcare systems in the New York area to emphasize high quality of care, and better patient outcomes. We have grown into New York's largest not-for-profit health insurer, and cover over 1.6 million members in New York City and on Long Is ...

The Associate of Strategic Account Management is a pivotal role responsible for a wide range of tasks to ensure that each Strategic Account Management team is aligned and delivers results. The Strategic Account Management Associate has responsibility for tracking and communicating daily, weekly, and ...

The Director, Medicaid Product Management will focus on Customer Retention and Quality. This Director role will be responsible developing and executing a Retention strategy for the Medicaid portfolio of products and ensuring that the products achieve top tier Quality. The Director will work cross-fu ...

The Team Lead, Claims assists the Claims Manager with managing the day to day operations of claims. She/he directly supervises a team of Claims Examiners assigned to new claims, provider correspondence and special handling. Additional tasks include oversight of letter generation process and review o ...

Healthfirst seeks a Social Media Marketing Manager to join our growing and dynamic corporate and marketing communications team. The ideal candidate has superb news judgement, a passion for creating compelling digital content and a strong interest in working for a mission-driven organization that foc ...

The Senior Data Product Manager will help create and deliver best-in-class data products and drive the creation and execution of product roadmaps for innovative solutions based on data capabilities such as machine learning, geospatial analysis, natural language processing and advanced data visualiza ...

Growing software company based in Setauket, NY is looking for a multi-faceted individual to serve as our IT Security Administrator.  Applicants must have experience in designing, installing, and maintaining systems and networks as well as familiarity with the NIST 800-171 Security Framework. This po ...