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The Manager of Actuarial Services at Healthfirst is responsible for monitoring the financial performance of the Medicare line of business, providing insights in business decisions, and conducting various actuarial functions. Duties include monitoring experience, supporting Medicare bids, analyzing market landscape, and managing staff.

The Support Coordinator assists care/case managers with non-clinical activities, handles member inquiries, documents member information, manages caseload, and escalates issues as needed. Responsible for telephonic outreach and administrative duties within a clinical team.

The Remote Case Manager - Utilization Management coordinates care plans for assigned members, conducts pre-certification, concurrent review, discharge planning, and case management. Ensures efficient utilization of health services, optimal outcomes, and meets quality metrics. Provides case management services, reports questionable healthcare services, and meets performance metric requirements. Acts as a clinical resource for the care team and identifies alternative care options based on member needs. Requires distinct healthcare licenses and preferred master's degree and relevant experience in managed care and case management.

Lead network optimization efforts by maximizing operational and reimbursement efficiency between Healthfirst and network partners. Develop and implement best practices for growth and optimization. Analyze data to identify payment integrity issues and solutions. Serve as an advocate for Hospital Providers within Healthfirst.

The Actuarial Analyst for Medicare will be responsible for actuarial analysis, pricing, forecasting, risk score analytics, data analysis, and reporting for Healthfirst's Medicare products. Duties include handling data for reports, performing analytics, assisting in bid processes, and monitoring product performance. Bachelor's degree in Actuarial Science or related fields is required, along with strong Excel skills, data analysis abilities, and communication skills.

The Senior Manager of Audit & Compliance Analytics leads analytics efforts to support Compliance and Internal Audit teams. This role develops strategies for high-priority analytics, manages stakeholder needs, oversees implementation of analytics solutions, and presents findings to various stakeholders, driving data-informed decision-making.

Healthfirst is seeking an HR Project Manager to lead and implement complex enterprise-wide projects, focusing on organizational development and leadership development. The role involves scoping, planning, and executing projects, managing stakeholders, and ensuring timely implementation. This is a hybrid position based in New York City.