Search the 35 jobs at Healthfirst, Inc

The Principal Cloud Database Engineer designs, implements, and manages cloud database solutions, optimizing performance, ensuring data security, and facilitating collaboration across teams. Responsibilities include database administration, automation, monitoring and troubleshooting, while also leveraging cloud technologies and scripting for continuous improvement and integration with development processes.

The A&G Dismissal Specialist manages member complaints and appeals related to clinical and non-clinical services, ensuring compliance with regulations. Key responsibilities include case development, researching issues, communicating with various departments, making decisions on cases, and adhering to regulatory timeframes.

The Payment Policy Analyst at Healthfirst ensures compliance with reimbursement policies and regulatory guidelines. They conduct market research on Medicaid and CMS methodologies, develop and draft policies, collaborate with various departments, and prepare reports for governance committees. The role requires effective communication and maintaining confidentiality in compliance with HIPAA regulations.

The Senior Manager of Performance Improvement leads initiatives to enhance business processes and deliver measurable value aligned to strategic goals. Responsibilities include managing projects, mentoring staff, and coaching teams in performance improvement methodologies. The role requires strong leadership and collaboration with stakeholders to drive project success.

The Senior MuleSoft Application Developer leads the development of high-performing solutions within the Correspondence program, applying API-led connectivity and collaborating within an Agile framework. Responsibilities include configuring APIs, designing enterprise services, documenting operational tasks, and supporting the existing technical stack.

The Case Manager coordinates care plans for assigned members, manages pre-certification and concurrent reviews, and ensures optimal health outcomes. Responsibilities include conducting assessments, collaborating with healthcare providers, documenting interventions, advocating for member services, and monitoring performance metrics.

The Manager of Product Management and Strategy leads cross-functional efforts to enhance market growth strategies for the senior market portfolio. Responsibilities include analyzing membership experience, managing competitive intelligence, optimizing revenue opportunities, and ensuring alignment with regulatory changes. The role requires collaboration with finance, sales, and marketing to derive actionable growth and retention plans, backed by effective communication and reporting on program success.

The Senior Product Specialist leads product optimization initiatives, collaborates with cross-functional teams, and ensures successful execution of projects. Responsibilities include monitoring activities, communication across departments, and acting as a subject matter expert on product requirements. This role involves adapting to changes and managing multiple priorities effectively.

The Senior Manager of OD & Employee Experience will lead efforts to enhance employee experience across Healthfirst by designing tools and processes to understand employee needs, developing action plans for improvement, and leading initiatives that enhance organizational effectiveness. Collaborating with HR and various stakeholders, the role focuses on operationalizing ideas, measuring impacts, and maintaining current knowledge of industry innovations.

The Strategic Account Management Associate coordinates activities for a cross-functional team of hospital account managers, documents workflow changes, conducts research and reporting, and ensures effective communication among teams. This role involves learning about the Healthfirst business and supports project implementations while working closely with various departmental partners.

The Coding Educator oversees and educates providers on proper coding practices to ensure compliance with CMS and ICD10 CM guidelines. Responsibilities include auditing clinical documentation, responding to provider inquiries, conducting training sessions, creating educational materials, and managing coding accuracy audits.

The Manager of Network Account Management will lead a team to develop and manage provider relationships, enhance quality and drive membership growth. Responsibilities include strategic planning, negotiating agreements, and collaborating with internal stakeholders to achieve business goals.

The Manager, Enrollment & Billing oversees enrollment and billing operations at Healthfirst, ensuring operational efficiency, accuracy, and compliance with policies. They are responsible for managing team performance, resolving issues through cross-functional collaboration, and implementing processes to ensure payment integrity. The role includes monitoring productivity, employee development, and achieving departmental goals.

The Network Account Manager represents and advances Healthfirst interests in the Provider market through superior customer service and execution of Provider engagement strategies. Responsibilities include serving as a plan liaison, resolving issues, provider recruitment, negotiating rates, monitoring performance, and contributing to strategic improvement plans.

The Manager of Actuarial Services oversees the financial monitoring of the Medicare line of business, offering insights, conducting annual filings, and managing financial audits. They also engage in forecasting, budgeting, and advising on the impact of regulatory changes, while leading and directing staff in day-to-day operations.

The Team Lead, Workforce Systems & Reporting is responsible for leading a team of analysts, ensuring operational effectiveness, coordinating workflows, analyzing data, and implementing reporting tools. They will also manage testing and project goals while recommending improvements based on analyses to enhance the performance of the Contact Center Operations.

The Senior Recruiter will lead high-volume recruitment for Call Center Operations, utilizing innovative sourcing techniques and technology. Responsibilities include developing talent sourcing strategies, leveraging CRM platforms, acting as an employment brand ambassador, and tracking ROI on sourcing efforts. The role emphasizes building strong relationships with hiring managers and efficiently managing multiple requisitions.

The Manager, Network Account Management will oversee the Account Team, focusing on building relationships with key providers to enhance engagement, quality, and profitability. Responsibilities include strategic planning, negotiating provider agreements, coordinating internal resources, and implementing projects while understanding market trends.

The Team Lead, Operations Analytics will manage the analytics team, supervise daily activities, oversee report generation processes, collaborate with business partners to improve processes, conduct root cause analysis, and ensure quality outcomes while providing training and mentorship to the team.

The Senior Social Media Manager is responsible for developing and implementing a comprehensive social media strategy, analyzing performance data, managing content development, overseeing community management, and staying up-to-date with social media trends. This role requires strong leadership, communication, and analytics skills to drive brand awareness and engagement in the social media space.