Jobs at Healthfirst, Inc

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

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

Manage utilization management functions and supervise RN/social work/care coordination teams. Ensure appropriate, cost-effective member services via authorizations, chart review, EMR documentation, staff coaching, operational reporting, and regulatory compliance with CMS/DOH.

The Executive Legal Assistant supports the Chief Legal Officer, providing administrative assistance and handling legal documentation, meetings coordination, and other departmental tasks.

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.

Serve as Product Owner for Provider Data Operations: define product vision, prioritize and maintain backlog, author and accept user stories, create UAT test cases, support Agile/Scrum processes, collaborate with cross-functional and stakeholder teams, drive process improvements, and ensure delivery of high-quality features. Hybrid role (Tues/Wed/Thurs in NYC).

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.

Track, analyze, and report on operational processes and data; produce regular reports and dashboards; respond to inquiries; support audits, compliance, system testing, SLA adherence, reconciliation, and process improvement with cross-team coordination.

Serve as Product Owner for enrollment and billing correspondence systems: prioritize backlog, write and accept user stories, lead UAT, drive process improvements, partner with cross-functional teams, and ensure Agile best practices and product strategy alignment.

Lead strategy, design, and execution of HR technology solutions, driving data architecture, governance, integrations, vendor management, reporting/analytics, AI use cases, and team development to improve employee experience and operational outcomes.

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.

Provide analytical support to Medicaid Product Strategy: build reports and forecasts, analyze financial and membership trends, create recommendations, maintain competitive and ad-hoc reporting, and develop models using Excel, Tableau, SQL/SAS. Collaborate cross-functionally and manage projects to support profitable market growth.

Lead strategy and operations for provider payment configuration, ensuring accurate reimbursement rates, benefits configuration, provider onboarding, credentialing, and provider database maintenance. Oversee testing, controls, regulatory compliance, and cross-functional alignment. Build and manage a team, improve provider payment experience, and support stakeholder requirements and audits.

The Senior Reconciliation & Recovery Analyst ensures accurate member data, supports premium collection from the State, performs complex data analyses, and collaborates across teams to resolve discrepancies and improve processes.

Lead and mature a claim configuration quality audit function to validate provider reimbursement accuracy and compliance. Develop risk-based audit plans, testing methodology, analytics strategy, reporting, and remediation governance. Manage analysts, oversee audits and data analysis, quantify financial impact, present findings to leadership, and drive control and process improvements across claims, provider configuration, and payment validation.

Perform routine and risk-based audits of claims configuration and provider reimbursement across lines of business. Validate claim outcomes against contracts and regulations, identify defects and financial impact, analyze data for trends/root causes, prepare workpapers and reports, coordinate remediation and retesting, and act as subject-matter resource for claims configuration and quality.

The Peer Support Specialist supports members with mental health and substance use issues, coordinating care and linking them to resources while modeling recovery through lived experience.

Provide peer-based recovery support to members with mental health or substance use disorders via field visits and phone outreach. Manage caseloads, complete assessments, coordinate care and referrals, document encounters, liaise with providers and interdisciplinary teams, and assist with navigation and linkage to community resources.