- Healthfirst (IN)
- …+ Work directly with appropriate members of the department and other Healthfirst business units to understand project concepts, objectives and approach + Assess ... and prepare to address the operational impacts, workflow, and training issues of the assigned project(s) **Minimum Qualifications:** + High School diploma or GED equivalent from an accredited school + Demonstrated ability to work within regulatory and… more
- Healthfirst (NY)
- …Facilitate and deliver learning events to support the enterprise inclusive of all business units. Serve as subject matter expert (SME) in the strategy creation, ... design and development of learning content partnering with business leaders and the instructional design group. Assist with maintaining and updating all learning content materials, ensuring they meet state, federal or organizational criteria. Partner and… more
- Healthfirst (NY)
- …and recruitment of the Behavioral Health networkbased on department needs and Healthfirst priorities. + Negotiates and executes Single Patient Agreement for Out of ... Microsoft PowerPoint presentations and other documents. Educate providers on Healthfirst policies and procedures such as billing, authorization, utilization of… more
- Healthfirst (FL)
- …+ Database Design and Implementation: Design, develop, and implement cloud-based database solutions in collaboration with development teams. Create database schemas, ... tables, and indexes to support efficient data storage and retrieval. + Cloud Database Administration: Manage, monitor, and optimize cloud database instances to ensure high availability, performance, and data integrity. Configure and maintain database backups,… more
- Healthfirst (NY)
- …of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital performance. **Minimum Qualifications:** + Bachelors degree from ... an accredited institution. + Analytical work experience within the healthcare industry (ie, hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) +… more
- Healthfirst (NY)
- …member and departmental information; adhere to local, state, federal and Healthfirst specific compliance and regulatory guidelines. + Additional duties as assigned. ... **Minimum Qualifications:** + High school diploma or GED. + Fluency in reading and speaking English and additional language. + Member/ Customer Service experience. + Capability to work in a remote environment with reliable internet connection. + Tech Savvy… more
- Healthfirst (NY)
- …+ Demonstrated technology subject matter expertise in Data Architecture and Governance. + 15+ years of leadership experience in Data software development and business ... + Develop the Data Strategy and partner with all levels of leadership on ways to improve the Information Management Program. + Interface with IT and business leadership to provide thought leadership on Data Architecture and Governance + Assist in managing… more
- Healthfirst (NY)
- …+ Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital performance. + Manage and train a team of analysts. ... + Perform ad hoc analyses. **Minimum Qualifications:** + Bachelors Degree from an accredited institution. + 4+ years of experience in the managed care industry related to analytics. + Extensive knowledge of managed care financial metrics (PMPM, util/k,… more
- Healthfirst (FL)
- …+ Assist in the on-going evaluation of configuration for new and existing claims business rules including member benefits, claims editing, reference data and system ... functionality within the claims processing system. + Analyze explanation of coverage documents to assist with determining best approach for configuring benefits offered including member cost shares, deductibles and out-of-pocket maximums. + Assist in the setup… more
- Healthfirst (FL)
- …robust sourcing strategies that feed critical talent pipelines flowing into the Healthfirst talent community. Reduce cycle time for future requisitions by ensuring ... structured talent pipelines contain talent profiles that meet the Healthfirst definition of success + Utilize our CRM platform (Avature) to drive direct prospect… more
- Healthfirst (NY)
- …Regulatory and Compliance to ensure compliance with CMS regulations and Healthfirst policies and procedure **Minimum Qualifications:** + Bachelors degree required or ... relevant experience + Accident & Health license + 5 + years of experience in a rapid-growth environment + Past leadership position managing a Telesales team + Knowledge and understanding of Medicare Advantage, as well as broader the Medicare product spectrum… more
- Healthfirst (NY)
- …delivery of technical components within existing frameworks and methodologies required by Healthfirst . + Represents Healthfirst Operations in the development of ... business requirements and associated artifacts by developing a deep understanding of business needs, and by collaborating closely with peers, leaders, and staff throughout Operations to ensure the appropriate parties are contributing. + Works with team to… more
- Healthfirst (Enfield, NY)
- …home visits per day (clustered in small geographic areas) + Supports the Healthfirst clinical team members, including UAS nurses and Care Managers, by facilitating ... needed, escalates member questions, as directed + Properly documents findings in Healthfirst information systems + Collaborates with other members of the clinical… 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 (NY)
- …Duties/Responsibilities:** + Work collaboratively with finance analysis, sales, marketing, Intake & Enrollment, and other departments as necessary to support market ... growth plans to achieve market growth and profitability objectives + Compile information from multiple sources to prepare and distribute time-sensitive and accurate reporting for internal and external audiences + Support team in analysis of the financial… more
- Healthfirst (MD)
- …to ensure comprehensive and defensible claims editing is in place across all Healthfirst product lines + Participate in special projects and advanced Claims Coding ... reports on performance of current claims editing packages to substantiate savings to Healthfirst + Serves as a subject matter expert to defend claims payment policy… more
- Healthfirst (NY)
- …staff are equipped to perform job responsibilities in accordance to Healthfirst standards and rules/regulations set forth by regulatory and compliance agencies. ... + Facilitates with subject matter experts, instructional designers, training agencies and technical assistance facilitators to design and deliver innovative learning solutions for performance enhancements needed to support the clinical departments business… more
- Healthfirst (NY)
- …+ Support initiatives to resolve gaps in care through direct provider and member outreach, collaboration with provider engagement, and leveraging our pharmacy network ... capabilities + Ensure that all recommendations are consistent with the latest guidelines or otherwise supported by the clinical compendia + Provide clinical pharmacy support to pharmacy technicians as they conduct outreaches to members regarding med adherence,… more
- Healthfirst (NY)
- …+ Identify areas of profitable growth opportunity + Identify improvements in the membership experience + Review and summarize key CMS regulatory updates with a ... concentration on RX changes ensuring alignment with organizational goals + Work collaboratively with finance analysis, sales, and marketing to develop market growth and retention plans to achieve membership objectives + Identify key opportunities around… more
- Healthfirst (NY)
- …+ Act as a key stakeholder in supporting company-wide programs and then analyze data to provide business insights. + Manage the HRSS knowledge base content and ... develop reference tools and provide training to ensure the teams readiness in responding to inquiries accurately. + Lead of a team of direct reports; train, coach and develop team members. + Provide recommendations on ways HR can refine processes to build… more