- Healthfirst (NY)
- …and accurate reporting of HQIP outcomes to internal staff and external Healthfirst providers. + Develops and delivers presentations for varying levels of staff ... buy-in on strategy or operational decisions + Designs and executes the Healthfirst Quality Incentive Program (HQIP) and other quality incentive programs. +… more
- Healthfirst (MA)
- …your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, ... Healthfirst offers employees a full range of benefits such...401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits… more
- Atlantic Health System (Newark, NJ)
- …Primary Care physician to become a valuable member of Atlantic Medical Group (AMG) Healthfirst Associates in Newark, New Jersey. This role is ideal for an ambitious ... and skilled internal medicine physician to join a well-established and busy practice with a cohesive team, strong support staff, and a large patient panel, ages 18+. This office is new and houses on-site parking and an in-house lab. The office is in walking… more
- Healthfirst (NY)
- …directory data quality, credentialing, and other areas that impact the Healthfirst delivery system + Evaluates, develops, and recommends strategic plans to ... of strategic plans in alignment with the future vision of Claims , Healthfirst delivery system and the company. + Establishes and communicates current and… 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)
- …steps related to complex government regulations. + Collaborate with the Healthfirst Compliance department, oversees the implementation and effectuation of all plans ... requirements are met. + Be responsible for bringing pertinent items to Healthfirst Regulatory Change Management and seeing projects through to fruition to ensure… more
- Healthfirst (NY)
- …utilization, and quality data + Partner with departments across Healthfirst , including Medical Management, Population Health, Clinical Quality, Delivery Systems ... with community partners, state agencies, and provider organizations + Represent Healthfirst on local, state, and industry workgroups, helping to shape behavioral… more
- Healthfirst (Enfield, NY)
- …in assigned territories. Special focus on reaching the Asian community in the Healthfirst service area (NYC). + Identify opportunities to tell the stories created by ... partnerships and relationships + Demonstrated professionalism in public spheres to represent Healthfirst in the target communities + Must be willing and able to… 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)
- …and departmental information, and adheres to local, state, federal and Healthfirst specific compliance and regulatory guidelines. + Builds sustainable relationships ... of trust through open and interactive communication with internal and external customers. + Works a flexible schedule including a late shift, weekends, and/or holidays (with limited notice at times), and as needed during unforeseen business disruptions. +… more
- Healthfirst (NY)
- …+ **_Managing day to day operational issues and concerns from hospital partners_** including but not limited to roster maintenance and claim issue root cause analysis ... + **_Managing education/training regarding company-wide initiatives_** including but not limited to new product implementation, regulatory initiatives, and other various health plan business objectives + **_Serving as an advocate for Hospital Providers within… 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)
- …+ Under the guidance of the Director of Communications at Healthfirst , identify media opportunities, develop pitches, and proactively secure earned media ... coverage that supports Healthfirsts brand and business priorities. + Collaborate with Social Media team to execute engagement growth strategy, including monitoring trends, responding to inquiries, and amplifying Healthfirsts voice across social platforms. +… more
- Healthfirst (NY)
- …long-term care plan) + Knowledge or prior experience using ePACES and/or CMS-MARx + Healthfirst product knowledge of MLTC and MAP Plans WE ARE AN EQUAL OPPORTUNITY ... EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or… more
- Healthfirst (NY)
- …made. + Remain current on reporting and database technologies and ensure Healthfirst is leveraging existing systems to maximize optimal value. + Collaborate with ... Information Technology, Business Transformation and Operations teams to support effective department management including introducing new technology, system upgrades and reporting impacts and providing leadership dashboards to assist with managing our… more
- Healthfirst (Enfield, NY)
- …it. 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 Marketing… more
- Healthfirst (Enfield, NY)
- …updates when needed. + Strictly adhere to all CMS regulations and Healthfirst marketing guidelines. + Ensure all documentation is complete, comprehensive, clear, ... appropriately filled out including Application, Application Confirmation Form, Scope of Appointment and Application Submission Form, and Salesforce. + Provide competitive intelligence to management on any activities Healthfirsts market competitors are engaging… more
- Healthfirst (NY)
- …per week **Duties & Responsibilities:** + Prepare, review, and deliver Healthfirst reporting of financial statements using Statutory Accounting Principles. + Ensure ... all reporting submissions are filed on time, meet the highest standards and are supported by comprehensive documentation. + Perform the GAAP to STAT reconciliation process and Fluctuation comparative analysis including preparing journal entries required. +… more
- Healthfirst (OK)
- …Provides case management services for assigned member caseloads which includes: + Pre-certification performing risk-identification, preadmission, concurrent, and ... retrospective reviews to evaluate the appropriateness and medical necessity of treatments and service utilizations based on clinical documentation, regulatory, and InterQual/MCG criteria + Assessment - identifying medical, psychological, and social issues that… more
- Healthfirst (FL)
- …+ Responsible for case development and resolution of non-clinical cases, such as: certain types of claim denials, member complaints, and member and provider appeals. ... The end-to-end process requires the Specialist to independently: + Research issues + Reference and understand HFs internal health plans policies and procedures to frame decisions + Interpret regulations + Resolve cases and make critical decisions + Edit and… more