- Healthfirst (NY)
- …communicate performance, opportunities, budget versus actual, benchmark analysis to Healthfirst leadership. + Manage the development and implementation of corporate ... performance improvement campaigns and initiatives as needed + Collaborate and engage internal stakeholders such as Actuary, Delivery System Engagement, Information Technology, Product Management to ensure alignment across processes and work effort. + Provide… more
- Healthfirst (NY)
- …**:** + Scope, plan, and oversee project tasks, timelines, deliverables, and the internal and external people engaged in multiple projects + Works in deep partnership ... and daily collaboration with the OD program or project lead ensuring an agreed upon, timely, flawless delivery + Coordination of a variety of tasks which make enterprise-wide employee development programs run flawlessly, such as building and managing rosters,… more
- Healthfirst (NY)
- …care delivered, and communicating information to other providers + Partners with Healthfirst Pharmacists and other internal and external partners to communicate a ... medication treatment plan and/or coordinate and integrate an MTM intervention within the broader healthcare management services + Partners with community pharmacies to monitor and communicate member medication adherence + Performs patient health assessments to… more
- Healthfirst (NY)
- …+ Responsible for the overall strategy and delivery of high priority analytics supporting key enterprise and department initiatives + Oversees the development and ... implementation of analytics solutions that can be used to inform Audit and Compliance leaders on key performance indicators and department initiatives, including tracking of various performance metrics over time + Collaborate with stakeholders to understand… more
- Healthfirst (NY)
- …50% of job requirement. + Must be able to travel across the Healthfirst service area (Manhattan, Brooklyn, Queens, Bronx, Staten Island, Long Island, Westchester, ... Mid-Hudson). **Preferred Qualifications** + Bachelors degree from an accredited institution, preferred focus study area in Education, Healthcare Administration, Learning and Development or relatable field. + Ideal candidate will have a minimum 5 years of… more
- Healthfirst (NC)
- **Duties & Responsibilities:** + Facilitate the Healthfirst reimbursement and billing guidelines policy process, including developing new policies, monitoring ... and departmental information + Ensure adherence to local, state, federal, and Healthfirst specific compliance and regulatory guidelines and ensure a timely and… more
- Healthfirst (NY)
- …+ Maintains tracking tools to log audit results including areas of non-compliance and informing what areas of improvement are needed for discussion with management ... and/or at departmental team meetings + Assists with evaluating and analyzing aggregate quality performance data + Develops strategies for business performance improvement initiatives. This includes: identifying opportunities for improvement, problem… more
- Healthfirst (NY)
- …+ Identify and/or direct process improvement opportunities and provide preliminary benefit/financial valuation for project prioritization + Lead cross functional ... teams in successful completion of assigned projects; generate solutions to complex problems through utilization of problem-solving tools and methodologies + Maintain up-to-date knowledge of all assigned initiatives, with a focus on measurable value + Coach,… more
- Healthfirst (NY)
- + Analyze the financial performance of all Healthfirst products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate ... abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital performance. + Provide support to the departments… more
- Healthfirst (NY)
- …+ Leverage leading analytical tools to generate insights that facilitate key decisions by department leadership + Create accurate reports or insightful and ... user-friendly dashboards that meet stakeholders needs and lead to business insights + Identify and monitor cost and utilization trends and the root causes in health plan trend performance, providing recommendations for solutions + Utilize statistical tools to… more
- Healthfirst (NY)
- …sales and service. + Ensure interpersonal effectiveness among individuals both within Healthfirst and outside the organization. + Develop various Sales and Marketing ... strategies and policies which support the corporate and departmental goals + Develop, monitor and coach Sales Managers while Sales Mangers achieve overall performance. Must provide diligent supervision on Sales Managers ability to handle all aspects of their… more
- Healthfirst (NY)
- …+ Leads or participates in product-driven workgroups, to provide input to product designs/enhancements and implementation plans + Works with key stakeholders ... (including, but not limited to Regulatory, Claims Configuration, Provider Ops, Appeals & Grievance, Medical Management, Enrollment & Billing, Sales) to identify, scope and accurately implement new benefits, services, or other product changes, update processes… more
- Healthfirst (NY)
- …+ Develops and monitors team goals; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; routinely evaluates staffs clinical ... skills and technical comprehension; and ensures an atmosphere of open communication, teamwork, and empowerment to make informed decisions + Maintains and recommends appropriate staffing levels to guarantee safe and effective care management + Oversees… more
- Healthfirst (NY)
- …+ Provide support for the Hospital Organizations performance improvement work groups. + Monitor costs and revenue trends for Hospital Organizations and assist in ... understanding trends + Understand and analyze impacts of new program changes. + Responsible for creating, modifying, and updating analysis for Hospital Provider Organizations. + Respond to ad-hoc reporting requests from Network Management, Provider… more
- Healthfirst (NY)
- …: + Partners on the establishment of an effective HR Compliance Program, including identifying potential areas of HR compliance vulnerability and risk. + Leverages an ... internal network, within HR and across HF, to complete internal HR audits and address compliance opportunities, issues and gaps. + Establishes and maintains an audit calendar to proactively be prepared for regularly occurring audits and manages all HR… more
- Healthfirst (NY)
- …+ Reviews prior authorization requests and units for medications requested under the medical benefit + Assesses provider-submitted clinical information for clinical ... appropriateness based on predetermined clinical criteria + Sends notification to members and providers of authorization decisions via telephone, fax, or mail + Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH +… 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 (TN)
- …+ Collaborates within the Agile framework, fosters a team approach to software development (review code) and delivery (release activities and postproduction ... validations) + Apply API-led connectivity concepts to business initiatives to help program achieve their goal + Configuring APIs, API portals, proxy endpoints and API analytics based on technical specifications with MuleSoft API manager + Designing and… more
- Healthfirst (MT)
- …+ Analyze contract terms, prepare fee schedules and accurately document file changes into the claims processing system + Research and identify published updates to ... payment methodologies, fee schedules and claims editing policies from Medicare, Medicaid, and third-party sources. + Responsible for the overall success of implementations including applicable testing and results verification before sign-off and Production. +… more
- Healthfirst (NY)
- …+ Maintain and develop relationships with elected officials and staff. + Represent Healthfirst at meetings with elected officials and staff. + Serve as liaison to ... matter experts and advise on its varied implications for Healthfirst . + Work closely with other Healthfirst ...for Healthfirst . + Work closely with other Healthfirst staff in pursuit of funding and/or programmatic opportunities.… more
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