- Healthfirst (CT)
- …+ **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… more
- Healthfirst (NY)
- …Administration as needed.** + **Engage in mastering the Divisions impact on Healthfirst and its Members.** + **Contribute creative solutions and ownership of daily ... assignments for seamless communication and systematic completion of routine and special projects.** + **Maintain the highest level of integrity, courtesy, and respect while interacting with clients, employees, and business contacts.** + **Assists with… more
- Healthfirst (NY)
- …dental and vision services including contractual provisions, authorizations and Healthfirst policy and procedure.** + **Prepare written reports concerning ... investigation activities and present results of investigations to senior staff.** + **Complete subsequent auditing and handling of specific claims and appeal requests including processing where applicable, tracking, documenting, reporting and dispersal of… more
- Healthfirst (NY)
- …+ **Manages designated caseload of members who could benefit from Peer Support services, care coordination, and health navigation** + **Schedules and conducts ... multiple field-based visits per day (clustered by geographic areas)** + **Completes assessments and questionnaires to identify barriers and opportunities for intervention** + **Works telephonically when not in the field to make outreach calls and receive… more
- Healthfirst (NY)
- …+ **Provide strategic direction and leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service ... requests** + **Develop strong operational and leadership capabilities within the organization through performance improvement, career development, and coaching** + **Develop and implement policies and procedures that align with industry standards, payer… more
- Healthfirst (NY)
- …of technical components within existing frameworks and methodologies required by Healthfirst .** + **Works across multiple departments 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 members to… 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** **Navigates… more
- Healthfirst (Enfield, NY)
- …visits per day (clustered in small geographic areas)** + **Supports the Healthfirst clinical team members, including UAS nurses and Care Managers, by facilitating ... escalates member questions, as directed** + **Properly documents findings in Healthfirst information systems** + **Collaborates with other members of the clinical… more
- Healthfirst (NY)
- …+ **LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (NY)** + **For CASAC positions only: Credentialed Alcohol and Substance Abuse Counselor** + **Ability to travel ... + 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… more
- Healthfirst (NY)
- …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… more
- Healthfirst (NY)
- …**Provide strategic oversight and operational management for all utilization management functions, including prior authorization, concurrent review, and service ... requests** **Lead, coach, and develop UM managers overseeing interdisciplinary teams of registered nurses, social workers, clinicians, and coordinators** **Ensure UM operations meet regulatory requirements set forth by CMS, New York State Department of Health… more
- Healthfirst (NY)
- **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 ... as well as in Westchester, Sullivan, Orange, and Rockland counties. Healthfirst accomplishes this all while collaborating with our hospital sponsors, provider… 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… more
- Healthfirst (FL)
- …innovations, with a recommended plan on how to leverage at Healthfirst .** + **Additional duties as assigned.** **Minimum Qualifications:** + **Bachelors degree ... flexibility in proactively addressing future challenges and opportunities specific to Healthfirst .** + **Certifications in one or more course authoring and… more
- Healthfirst (NY)
- …after shift scheduled.** + **Engage in mastering the Divisions impact on all Healthfirst Plans and its members.** + **Ability to create a positive impression during ... call center with telemarketing responsibilities within a healthcare environment.** + ** Healthfirst product knowledge of Complete Care, Senior Health Partners (SHP)… more
- Healthfirst (NJ)
- …+ **Conduct outreaches for newly enrolled members to review current and approved services, durable medical equipment (DME) and additional requests** + **Review intake ... documents for pre-approved services and escalate discrepancies as needed** + **Complete Welcome Onboarding and Consumer Directed Personal Assistant Assessments and identify any issues or risk factors that require clinical escalations to a CM//PCM.** +… more
- Healthfirst (NY)
- …+ Sales Support has the primary responsibility of connecting Healthfirst with community-based organizations, community health centers, NYCHA, community providers, ... faith-based organizations, community boards, and city agencies. + Develop twenty (20) events and//or opportunities per months for the sales representatives which they support. + Establish new relationships and maintain existing ones. + Support the Sales and… more
- Healthfirst (NY)
- …+ **Organizes and leads assigned process improvement projects using methods of team building, data gathering and analysis, process mapping, and problem solving** + ... **Works with appropriate stakeholders to develop and document key processes (like what) within DSE** + **Manages regular quality assurance audits on audit failures to ensure appropriate resolution has occurred (ie Access and Availability, compliance with… more
- Healthfirst (NY)
- …authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations.** + **The ... methodologies** **Compliance & Regulatory Responsibilities** **:** **Ensures compliance to internal Healthfirst and external regulations.** + **Licensed MD or DO or… more
- Healthfirst (Lake Mary, FL)
- …+ **_Maintain and update the VMS and SMS systems utilized by Healthfirst ._** + **_Maintain Healthfirst automated security systems and employee identification ... card system._** + **_Perform facility and security related audits of the premise to include but not limited to facility and security equipment._** + **_Submit Service Now tickets for any repairs or hazards that need to be addressed because of daily inspections… more