- Healthfirst (NV)
- …+ 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 call in designated PHI system. + Manages an assigned member caseload who require short term care coordination and health navigation + Works within… more
- Healthfirst (NY)
- …+ Comply with HIPAA guidelines and maintain confidentiality of member, provider, and departmental information. Adhere to state and federal compliance and regulatory ... guidelines. + Lead department of Team Leads and Mail Clerks to ensure departmental processes and procedures are followed. + Oversee mail operations: receiving, routing, distributing, printing and mailing correspondence and shipping & receiving parcels in New… more
- Healthfirst (NM)
- …+ HS Diploma or GED **Preferred Qualifications:** + Bachelors degree + Knowledge of related NY state and federal regulations highly desirable + Proficiency in ... Microsoft Office required + Knowledge of the New York state ART 44 PHL and federal regulatory environment + Knowledge of claims payment process and claims data system (MHS) + Ability to work both independently and as a team member + Demonstrated ability to be… more
- Healthfirst (PA)
- …+ Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued ... Stay, Reduction, Termination, and Suspension of services. The end-to-end process requires the Specialist to independently: + Research issues + Quality of Care Experience + Reference and understand HFs internal health plans policies and procedures to frame… more
- Healthfirst (PA)
- …and departmental information, and adheres to local, state, federal and Healthfirst specific compliance and regulatory guidelines + Additional duties as assigned ... **Minimum Qualifications:** + High School diploma or GED from an accredited institution + Prior experience in a customer service environment + Working experience in a fast-paced environment + Proficient in Microsoft Office Suite applications including Excel,… more
- Healthfirst (NY)
- …+ RN Conducts assessments for prospective members and re-assessments of current members as well as identify enrollment and or eligibility by utilizing clinical ... expertise and critical thinking skills. As needed, conducts assessments in settings other than home eg skilled nursing facilities. + RN conducts In-person Care Management visits in support of person-centered service planning. + RN Completes assessment of… more
- Healthfirst (NY)
- …+ Develops, promotes, and drives departmental studies and other related projects. + Ensures relevant deliverables are timely completed in accordance with ... organizational and other relevant policies. + Creates and monitors project plans and other required documentation such as workflows, protocols, and job aids. Certifies work is compliant with relevant regulations such as HHS reporting requirements. + Executes… more
- Healthfirst (NY)
- …+ Responsible for case development and resolution of non-clinical cases, such as: certain types of claim denials, member complaints, and non-par provider appeals. The ... end to end process requires the Specialist to independently: + Research issues + Understand claim denials + Communicate with other departments to confirm submitter information + Reference and understand HFs internal health plans policies and procedures 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)
- …timeliness, accuracy, and consistency. + Coordinates and communicates with Healthfirst Care Management teams regarding clinical eligibility issues, necessary service ... Director in directing, training, and developing team members by embodying the Healthfirst Trailblazer mindset and leading others by example. + Builds and develops… more
- Healthfirst (NY)
- …performance improvement. + Acts as subject matter expert on assigned Healthfirst quality ratings programs, including program and measure proposals /changes. ... Communicates with relevant stakeholders on proposed changes and their impact. + Drafts and refines comments to regulatory agencies, measurement bodies, coalitions, and other industry groups about quality ratings programs which incorporate input from… more
- Healthfirst (FL)
- …that may be required or assigned **Minimum Qualifications** + Experience working in an Agile environment as a Product Owner + Experience and track record of success ... directing the efforts of developers as a project manager or product owner in a deadline-driven and fast-paced environment + Ability to juggle multiple projects and tasks. Demonstrated knowledge of project management concepts (preferably Agile/SCRUM) + Hands on… more
- Healthfirst (NY)
- …+ Masters degree from an accredited institution. + Certifications such as PMP, Six Sigma Green Belt or LEAN. + Experience working in a Scaled Agile Framework (SAFe) ... + Manages portfolio of select Clinical Operations projects; from workplan development to stakeholder management to change management, implementation and metrics development and measurement + Develops and runs reports and performs complex analytics to monitor… more
- Healthfirst (NY)
- …+ Conducts home assessments (and virtual assessments, as needed) for prospective members and re-assessments of current members using the Uniform Assessment System ... (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills. As needed, conducts assessments in settings other than home as needed, eg skilled nursing facilities or virtually + Completes… more
- Healthfirst (NY)
- …and negotiation of provider, procurement, and other contracts affecting Healthfirst , the interpretation and dissemination of new legal requirements, obtaining ... maintaining records and preparing resolutions and Board materials for meetings of Healthfirst , Inc. and its subsidiaries. **Minimum Qualifications:** + JD Degree +… more
- Healthfirst (NY)
- …internally that have an impact on the physician. Coordinates with all Healthfirst staff to assist as appropriate, including creating project plans, issue logs, ... the tristate area. Engage in mastering the Division's impact on Healthfirst , its Members, and Providers **Minimum Qualifications:** + Medicare and/or Medicaid… more
- Healthfirst (NV)
- …+ 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 (UT)
- …+ Experience handling Personal Health Information (PHI) in a professional manner + Experience in an Auditing capacity where you have conducted root cause analysis + ... Ability and willingness to handle increasing workload and responsibility + Willingness and ability to learn and evaluate new information, both technical and procedural + Knowledge of at least two or more lines of business such as NY Medicare, Medicaid, Family… more
- Healthfirst (NY)
- …+ Providing support to in-house legal counsel or the organization's attorney to address legal issues + Reviewing and logging Fair Hearing notices; compiles and ... coordinates assembly of documentation supporting actions taken by the Plan + Assisting in handling, preparing, coordinating, and attending scheduled Fair Hearings on behalf of the Plan + Working with internal departments to coordinate and improve workflows… more
- Healthfirst (NY)
- …+ Primary designer and lead on a variety of enterprise OD and OE initiatives focused on, but not limited to, Organizational Design and Strategic Workforce Planning. + ... Develop the enterprise approach, frameworks, and tools to implement organizational design and strategic workforce planning across the organization. + The approach/frameworks must be based on proven, science-backed methods. + All tools, content, processes, and… more