Jobs at Healthfirst, Inc

Build predictive and machine learning models using complex healthcare data, explain key outcomes, and develop fair, responsible algorithms. Partner with stakeholders across data science, engineering, product, and business teams to deliver solutions that improve member and provider outcomes. Work with cloud technologies, experimentation, statistical modeling, AWS, SageMaker, and scalable data transformation pipelines.

The job description contains no specific responsibilities or qualification details for the Director of Business Contracting role.

Owns the architecture, integration, interoperability, monitoring, and reliability of Healthfirst’s HR technology ecosystem. The role designs Workday and vendor-system integrations, improves workflows and data integrity, resolves complex system issues, establishes governance and documentation, coordinates technical vendors, and partners with data teams. It also leads and develops a small HR Technology team while reducing manual work, operational demand, and dependence on IT and consultants.

Supports care and case managers with non-clinical coordination, authorization management, member and provider outreach, case documentation, mailings, faxing, scheduling, and issue escalation. Handles high-volume queues while maintaining quality, productivity, HIPAA compliance, and confidentiality. Provides customer service, updates member information, communicates care needs, and coordinates with internal teams, providers, and community organizations. Spanish fluency is preferred, along with healthcare, managed care, medical terminology, and CRM experience.

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.

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

Build and manage relationships with community organizations to connect New Yorkers to health-insurance resources. Plan and execute community events, track partnerships in Salesforce, report outcomes to leadership, evaluate engagement effectiveness, and support community members seeking assistance.

Leads cloud infrastructure and operations strategy across public and private clouds. Designs and manages enterprise systems, CI/CD pipelines, automation, Infrastructure as Code, hybrid cloud platforms, and operational standards. Serves as a technical SME and escalation point, mentors engineers, improves resiliency and efficiency, supports cloud governance and security, develops SOPs, troubleshoots complex incidents, and partners with development teams on cloud-native delivery and continuous improvement.

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.

Analyze financial performance and utilization for Healthfirst products, identify trends and root causes, build financial and reimbursement models, perform ad hoc and ROI analyses, support medical cost reduction projects, and collaborate with stakeholders across Finance, Network, IT, and provider networks to inform decisions and track impacts of Medicaid/Medicare reforms.

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 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.

The Senior Manager, HRBP-IT leads HR initiatives within the IT department, aligning people strategies with business goals while focusing on talent management and change during digital transformation.

Lead strategic engagement and high-stakes negotiations to convert out-of-network providers to in-network, secure competitive reimbursement rates, and improve network adequacy. Use market intelligence and utilization analytics to structure contracts, align with finance and legal, and ensure smooth onboarding. Track and report measurable outcomes, provide executive reporting, and serve as a subject-matter expert on reimbursement methodologies and provider market dynamics.

Front-line community office coordinator who greets and triages members, registers and educates on the member portal, audits applications, tracks office metrics, manages inventory/mail/calendar duties, escalates member and sales issues, conducts representative training, and ensures privacy/PHI protection while supporting office opening/closing and reporting.

The Director of Performance Improvement leads initiatives to enhance business processes and productivity, manages staff, and collaborates on strategy development.

The Coding Educator trains providers on diagnosis coding compliance, audits clinical documentation, manages inquiries, and develops educational materials to improve coding accuracy.

The Senior Social Media Manager will strategize and execute social media campaigns, analyze data, manage content development, and lead a team to enhance brand engagement.