- Healthfirst (NY)
- …+ LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (NY) + For CASAC positions only: Credentialed Alcohol and Substance Abuse Counselor + Ability to travel around ... downstate New York which includes the 5 boroughs, Long Island, and Westchester **Preferred Qualifications:** + Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along… more
- Healthfirst (NY)
- …+ Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. + Conducts assessments to identify barriers and ... opportunities for intervention. + Develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals. + Generates referrals to providers, community-based resources, and appropriate services and other… more
- Healthfirst (NE)
- …+ Chief technical designer for ServiceNow code and architecture, responsible for overall ServiceNow code quality + Design, prototype, implement, test, and deploy ... business rules, technical solutions, such as client scripts, UI pages/actions/policies, scheduled job, import sets and transform maps, ACLs and notifications + Develop custom integration components (SSO, CMDB, SAS connectors etc.) and integrate legacy systems… more
- Healthfirst (AL)
- …+ Prepare and plan the weekend staffs assignments and volume to ensure compliance + Triage and assign expedited appeals while helping standardize and optimize how ... Appeals and Grievances are routed + Manage inventory to ensure regulatory compliance for appeals processed through the weekend + Communicate and escalate cases to Medical Peer reviewers + Maintain delegated vendor relationships and ensure vendor performance… more
- Healthfirst (NY)
- …**Duties and Responsibilities:** + Receive incoming calls from members regarding benefit questions/issues, care coordination, program inquiries, connecting to their ... care manager, and screening assessments to identify risk factors requiring medical intervention + Contemporaneously and accurately documents calls in designated PHI system. + Manages an assigned member caseload who require short term care coordination and… more
- Healthfirst (WV)
- …Will be the primary point of contact for all delegated entities with regards to onboarding/credentialing providers. Responsible for the resolution of all issues, ... including those identified by the provider, and those identified internally that impact the physician. Schedules regular meetings with assigned delegated entities to identify and trouble shoot issues. Trains/educates entities on site regarding the onboarding… more
- Healthfirst (SD)
- …medical and departmental information; adhere to local, state, federal and Healthfirst specific compliance and regulatory guidelines + Additional duties as assigned ... **Minimum Qualifications:** + Bachelor's degree from an accredited institution or equivalent work experience + Experience related to customer services, network management, provider relations, or healthcare + Work experience with Microsoft Office Suite… more
- Healthfirst (NY)
- …+ Provides onsite and telephonic care management to support the members care needs to promote positive health outcomes + Applies care management principles by ... advocating, informing, and educating beneficiaries on services, self-management techniques, and health benefits related to the continuum of care + Reviews discharge planning, assessments, medical records, and screening for members recently discharged from… more
- Healthfirst (NY)
- …+ Partner with Finance Business Partner to support State Programs teams to monitor product financial performance + Collaborate with teams across the organization, ... including within the Finance Department, to connect the dots and understand all the levers to improve product performance + Support business case development for new growth and market opportunities for the State Programs products + Monitor budget versus… more
- Healthfirst (NY)
- …+ Operate with intellectual curiosity and critically assess existing processes and procedures to identify opportunities for improvement + Develop complex analyses ... requiring the integration of multiple data sources, evaluation of data quality, and standardization of data to consistent format/structure + Create advanced queries and reports that extract data to support business teams needs, including working with nesting… more
- Healthfirst (FL)
- …time and within budget + Achieves project objectives in conformance with Healthfirst project management methodologies and standards. + Coaches and mentors Project ... Managers and Coordinators + Additional duties as assigned. **Minimum Qualifications:** + Bachelors degree from an accredited institution or equivalent work experience + Certifications such as PMP, Six Sigma Green Belt or LEAN + Experience managing… more
- Healthfirst (NY)
- …+ Processes operating expense invoices utilizing Workday and related systems + Ensures accurate GL account coding and directs invoices to the appropriate workflow ... approvers for payment processing approval. + Ensures accurate and timely processing of invoices entered into the Accounts Payable module before posting the transaction to the General Ledger for payment processing. + Audits and reviews employee expense reports… more
- Healthfirst (NY)
- …+ Work as a senior member of the cloud engineering team + Develop automated capabilities to deliver capabilities more efficiently + Drive solutions to problems ... impacting mission critical systems and implement automation to prevent reoccurrence + Execute changes on production systems + Work in center of excellence for cloud usage and cloud development standards + Work closely with other development and operations team… more
- Healthfirst (FL)
- …etc.) + Ensures quality of technical solutions as data moves across Healthfirst environments + Provides insight into the changing data environment, data processing, ... works with data consumers on updates + Aligns data architecture to Healthfirst solution architecture; contributes to overall solution architecture + Helps maintain… more
- Healthfirst (FL)
- …+ Manage the relationship and resolution of Member inquiries with respect to all Healthfirst vendor partners in concert with or on behalf of the Member(s) + Meet ... medical and departmental information; adhere to local, state, federal and Healthfirst specific compliance and regulatory guidelines + Build sustainable relationships… more
- Healthfirst (FL)
- …+ Aligns Testing Support Services under the Quality Assurance Team for strategic planning as it pertains to organization standards. + Builds the testing process and ... policies along with defining technical solutions and tools to support the testing framework. + Ensures that standardized QA methods and procedures are used for efficient and prompt handling of all testing activities and automation opportunities. + Emphasizes… more
- Healthfirst (NY)
- …Attends community meetings and programs such as community board meetings, town hall meetings, dinners and galas, industry seminars and programs. + Manage Events ... On-site for all community and enterprise meetings/conferences. **Minimum Qualifications:** + High School Diploma or GED Equivalent + Demonstrated ability to effectively interact with people of diverse socioeconomic, cultural, disability, and ethnic backgrounds… more
- Healthfirst (NY)
- …to business decision logs, data universes, etc. + Partners with key Healthfirst stakeholders such as but not limited to Legal, Regulatory, Compliance, Finance, ... and Pharmacy to identify, understand, and process audit deliverables + Responds to regulatory actions and audit inquiries timely and effectively + Identifies and recommends process improvements to better ensure compliance with regulations + Additional duties… more
- Healthfirst (NY)
- …+ HS Diploma or GED **Preferred Qualifications:** + Bachelors degree + Knowledge of related NY state and federal regulations highly desirable + Proficiency in ... + Prepare cases for the clinical team by gathering documentation, loading evidence, and making calls to members and providers. + Perform administrative activities including but not limited to generating and printing determination and authorization notification… more
- Healthfirst (NJ)
- …+ Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. + Conducts assessments to identify barriers and ... opportunities for intervention. + Develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals. + Generates referrals to providers, community-based resources, and appropriate services and other… more