Jobs at Healthfirst, Inc

The Sr Project Manager leads enterprise transformation initiatives in Utilization Management, focusing on operational efficiency, technology enablement, and performance improvement in healthcare.

The AVP of Community Engagement leads Healthfirst's community health initiatives, driving partnerships, enrollment, and retention strategies to enhance member health and improve community well-being.

The Support Specialist assists with non-clinical tasks including outreach to members and providers, service assessment completion, documentation, and handling inquiries regarding services and authorizations.

The Appeals Specialist manages non-clinical case development and resolution for member and provider appeals across various health plans, ensuring compliance with regulations.

The Director of Utilization Management leads clinical operations for UM teams, ensuring compliance and quality care while driving process improvement and technology integration.

The Internal Audit Analyst assesses and evaluates internal controls, supports compliance with SOX, and manages audit documentation and testing.

The Director manages benefit configuration, ensuring compliance and effective structure. Oversees team performance and collaborates across departments for operational efficiency and regulatory adherence.

This program aims to provide recent graduates with immersive technology experiences, including training on technical skills within IT and Quality Assurance roles.

The Process Manager for Enrollment and Billing oversees process execution, ensures compliance, manages operational KPIs, and leads continuous improvement initiatives for health services.

Manage claims-related modernization initiatives, oversee project reports, collaborate with IT, and implement process improvements in a healthcare setting.

Lead strategic, cross-functional performance improvement initiatives to optimize clinical and operational performance, build organizational capability, and deliver measurable financial and customer outcomes through process optimization, automation, AI-enabled solutions, change management, and stakeholder engagement.

The Account Specialist identifies prospective members for health insurance, collaborates with providers for issue resolution, and conducts community outreach to promote health programs.

The Social Media Manager shapes Healthfirst's social presence through engaging content, community engagement, and data-driven optimization while collaborating with teams to elevate brand efforts.

The Director, Workforce Analytics leads the workforce analytics function, transforming data into insights to optimize talent strategy and support organizational goals through analytics and reporting.

The Network Account Manager serves as a liaison to providers, resolves issues, recruits new providers, monitors performance, and ensures quality engagement through superior service.

Support the Provider Risk Analytics team by performing data analysis and projects to monitor cost and revenue trends, identify improvement opportunities, model impacts for provider organizations, attend provider meetings, and learn value-based care and risk modeling.

Lead out-of-network contracting strategy and negotiations, manage provider relationships, ensure regulatory and contractual compliance, collaborate with legal/finance/clinical teams, analyze claims and reimbursement trends, develop policies and playbooks, and manage/direct a contracting team to optimize access and financial performance.

The Peer Support Specialist models recovery and supports members dealing with mental health and substance use, manages a caseload, facilitates care coordination, and collaborates with multidisciplinary teams.

The Technology Associate role is for recent graduates to gain experience in quality assurance and technology solutions through a development program. It includes project work, training, and mentorship to build technical and professional skills.

The AVP of Community Engagement leads strategies to enhance community health, improve member health outcomes, and operationalize initiatives aligning with marketing and enterprise objectives. Responsibilities include managing a team, executing community strategies, tracking outcomes, and building partnerships with local organizations.