Healthfirst

209 job(s) at Healthfirst

Healthfirst New York, NY
The Senior Manager, Claims Analytics is responsible for overseeing all aspects of claims analysis including analyzing weekly claim submission trends, tracking claims inventory, researching, identifying, and diagnosing root cause issues related to timely claims processing, and management and implementation of projects to improve operational effectiveness. The Senior Manager works in collaboration with stakeholders across Claims Operations, DSE, IT and Finance, to assess and develop key insights related to operational issues for Claims submission and Claims processing. This role requires an in-depth understanding of claims trends to drive insights on leading indicators in support of actuarial estimates for the financial close process.Job DescriptionDevelop and implement KPIs and other metrics to identify trends and patterns regarding claims submission and claims processing data at the provider level Assess and monitor claims submission to ensure timeliness and avoid provider abrasion Define and develop analytical tools to identify and understand claim trends, drive insights, and support actuarial estimates, including the development of IBNR, for financial close Conduct root cause analysis to identify claims inventory issues and recommend appropriate solutions and process improvementsPartner with stakeholders from DSE to identify and resolve issues related to accurate and timely submission of provider claim analysisCollaborate across the enterprise to support claims analysis and ensure the timely processing of settlement payments to providersCoordinate reports to analyze trends, performance results and requests for root cause analysisSubject matter expert responsible for researching and determining underlying problem areas, analyzing trends, and recommending solutions to improve processes and resolve issues.Prepare high level and detailed summary reports for regular distribution and presentation to internal stakeholdersEstablish regular cadence of reporting and analysis to track claims processing data and derive key insights Support analysis of claims data required for settlement negotiations with providersOther duties as assignedMinimum QualificationsBachelors Degree from an accredited school or equivalent work experiencePrevious experience with healthcare claims and claims system set-upFamiliarity with the full claims adjudication process (i.e., claims audit functions, reporting and trending, etc.) and the ability to identify and implement process improvementsExperience working with outside entities and/or governing agencies (i.e., Centers for Medicare & Medicaid Services- CMS, Department of Banking, and Insurance- DOBI, state representatives, or other regulatory agencies) regarding managed care audit processesStrong proficiency with both Excel and PowerPointPrevious exposure to New York State Department of Health requirements for managed care benefit issues and claims processing requirements, and an understanding of medical terminologyPrior experience working with MHS, Macess or other document process mapping systems (i.e., Visio, etc.)Preferred QualificationsExperience in assessing and resolving problemsDemonstrated project/program management skillsAbility to work with team members across the enterprise to diagnose and translate departmental needs into efficient business solutionsDemonstrated experience working in collaboration with other departments to foster cooperation and team spirit in a high-volume, high-pressure environment.Master’s degree from an accredited programPlease note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Data Engineer on the Platform & Provider Collaboration team, is responsible for data acquisition strategies and integration scripting and tools, data migrations, conversions, purging and back-ups; fulfills data acquisition strategy requirements. They work with product, financial control, analysts, users and other stakeholders to understand business requirements and supports data architecture to translate into data acquisition strategies. The Data Engineer will author artifacts defining standards and definitions for storing, processing and moving data, including associated processes and business rules. Additionally, the Data Engineer will map the details within these their artifacts to business processes, non-functional characteristics, QA criteria and technical enablement. The role is responsible to be constantly thinking through the needs of the business to support efficient and error free processes.Job Description The Data Engineer, Platform & Provider Collaboration, will be responsible for finding trends in datasets and developing workflows and algorithms to help make raw data more useful to the enterprise. He or she will also be responsible for creating data acquisition strategy and develops data set processes.Designs and implements standardized data management procedures around data staging, data ingestion, data preparation, data provisioning and data destruction (scripts, programs, automation, assisted by automation, etc).Ensures quality of technical solutions as data moves across Healthfirst environmentsProvide insight into the changing data environment, data processing, data storage and utilization requirements for the company and offer suggestions for solutionsEnsures managed analytic assets support Healthfirst’s strategic goals by creating and verifying data acquisition requirements and strategyDevelop, construct, test and maintain architecturesAlign architecture with business requirements and use programming language and toolsIdentify ways to improve data reliability, efficiency and qualityConduct research for industry and business questionsDeploy sophisticated analytics programs, machine learning and statistical methodsPrepare data for predictive and prescriptive modeling and find hidden patterns using dataUse data to discover tasks that can be automatedCreate data monitoring capabilities for each business process and work with data consumers on updatesAligns data architecture to Healthfirst solution architecture; contributes to overall solution architectureHelp maintain the integrity and security of the company dataMinimum Qualifications:Bachelors degree in computer science or related field2+ years’ experience in data engineering2+ years’ experience in data programming languages such as R or Python2+ years’ experience working in a Big Data ecosystem processing data; includes file systems, data structures/databases, automation, security, messaging, movement, etc.4 years experience well versed with multi-threaded applications, file based integrations and database integra3+ years’ experience working in a production cloud infrastructureProficiency with relational, graph and noSQL databases required; expertise in SQLPreferred Qualifications:Proven track record of success directing the efforts of data engineers and business analysts within a deadline-driven and fast-paced environmentHands on experience in leading healthcare data transformation initiatives from on-premise to cloud deploymentDemonstrated experience working in an Agile environment as a Data EngineerHands on work with Amazon Web Services, including creating Redshift data structures, accessing them with Spectrum and storing data in S3Proven results using an analytical perspective to identify engineering patterns within complex strategies and ideas, and break them down into engineered code componentsKnowledge of provider-sponsored health insurance systems/processes and the Healthcare industryExperience developing, prototyping, and testing engineered processes, products or servicesProven ability to work in distributed systemsMust be able to develop creative solutions to problemsDemonstrates critical thinking skills with ability to communicate across functional departments to achieve desired outcomesExcellent interpersonal skills with proven ability to influence with impact across functions and disciplinesAbility to work independently and as part of a teamAbility to manage multiple projects/deadlines, identifying the necessary steps and moving forward through completionSkilled in Microsoft Office including Project, PowerPoint, Word, Excel and VisioWE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Senior Data Engineer on the Platform & Provider Collaboration team, is responsible for data acquisition strategies and integration scripting and tools, data migrations, conversions, purging and back-ups; fulfills data acquisition strategy requirements. They work with product, financial control, analysts, users and other stakeholders to understand business requirements and supports data architecture to translate into data acquisition strategies. The Senior Data Engineer will author artifacts defining standards and definitions for storing, processing and moving data, including associated processes and business rules. Additionally, the Sr Data Engineer will map the details within these their artifacts to business processes, non-functional characteristics, QA criteria and technical enablement. The role is responsible to be constantly thinking through the needs of the business to support efficient and error free processes.Job DescriptionThe Senior Data Engineer, Platform & Provider Collaboration, will be responsible for finding trends in datasets and developing workflows and algorithms to help make raw data more useful to the enterprise. He or she will also be responsible for creating data acquisition strategy and develops data set processes.Designs and implements standardized data management procedures around data staging, data ingestion, data preparation, data provisioning and data destruction (scripts, programs, automation, assisted by automation, etc).Ensures quality of technical solutions as data moves across Healthfirst environmentsProvide insight into the changing data environment, data processing, data storage and utilization requirements for the company and offer suggestions for solutionsEnsures managed analytic assets support Healthfirst’s strategic goals by creating and verifying data acquisition requirements and strategyDevelop, construct, test and maintain architecturesAlign architecture with business requirements and use programming language and toolsIdentify ways to improve data reliability, efficiency and qualityConduct research for industry and business questionsDeploy sophisticated analytics programs, machine learning and statistical methodsPrepare data for predictive and prescriptive modeling and find hidden patterns using dataUse data to discover tasks that can be automatedCreate data monitoring capabilities for each business process and work with data consumers on updatesAligns data architecture to Healthfirst solution architecture; contributes to overall solution architectureHelp maintain the integrity and security of the company dataMinimum Qualifications:Bachelors degree in computer science or related field5-7 years’ experience in data engineering5-7 years’ experience in data programming languages such as R or Python5-7years’ experience working in a Big Data ecosystem processing data; includes file systems, data structures/databases, automation, security, messaging, movement, etc.5-7 years experience well versed with multi-threaded applications, file based integrations and database integrations5-7 years’ experience working in a production cloud infrastructureProficiency with relational, graph and noSQL databases required; expertise in SQLPreferred Qualifications:Experience building out production level visualization dashboards using tools such as Tableau or qlikviewProven track record of success directing the efforts of data engineers and business analysts within a deadline-driven and fast-paced environmentHands on experience in leading healthcare data transformation initiatives from on-premise to cloud deploymentDemonstrated experience working in an Agile environment as a Data EngineerHands on work with Amazon Web Services, including creating Redshift data structures, accessing them with Spectrum and storing data in S3Proven results using an analytical perspective to identify engineering patterns within complex strategies and ideas, and break them down into engineered code componentsKnowledge of provider-sponsored health insurance systems/processes and the Healthcare industryExperience developing, prototyping, and testing engineered processes, products or servicesProven ability to work in distributed systemsMust be able to develop creative solutions to problemsDemonstrates critical thinking skills with ability to communicate across functional departments to achieve desired outcomesExcellent interpersonal skills with proven ability to influence with impact across functions and disciplinesAbility to work independently and as part of a teamAbility to manage multiple projects/deadlines, identifying the necessary steps and moving forward through completionSkilled in Microsoft Office including Project, PowerPoint, Word, Excel and VisioWE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Field Service Agent acts as an in-person liaison between Healthfirst and its customers. The individual is responsible for assisting customers with issues and inquiries they may have about their insurance, applications and/or claims not paid. The Field Service Agent is also responsible for receiving and addressing member inquiries, resolution of customer complaints, client education, retention of membership and dis-enrollments.Interacts with customers in person to provide information in response to inquiries about products and services.Improve overall member experience and reduce waiting time in order to expedite traffic flowIdentify, research, and resolve customer issues using appropriate methods and tools.Effectively manage face to face encounters.Register and educate members in the HF Member portal (access online services)Handle and resolve customer complaints.Ability to navigate through information systems to analyze the customer’s situation.Serves as a liaison between the customer and various departments.Serve as Privacy Ambassador in order to ensure security, integrity and confidentiality of data/protect PHI in CBOCBO Triage on the weekends: Use OnContact and product knowledge to screen walk-ins and identify who is applying, renewing, making payment, inquiring MS, etc.Customer Support: Escalate member concerns to Enrollment & Billing, MS ResolutionsOther duties as assigned by the management team.Work flexible schedules, nights, weekends, holidays, and/or overtime with limited notice.Ability to multi-task, prioritize, and manage time effectively. Bilingual English/Mandarin and/or CantoneseMinimum Qualifications:High School Diploma or GED equivalent from an accredited institution.Work experience in a face to face or call center environment.Communicate effectively verbally and in writing while demonstrating good grammar, spelling and punctuation skills.Strong active listening skillsPreferred Qualifications:Associates Degree from an accredited institution.Compliance & Regulatory Responsibilities: see aboveLicense/Certification: NAWE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Business Analyst is responsible for reporting, business process review and data analysis relating to activities ensuring operational effectiveness. The BA will assist management by developing and maintaining reporting tool and processes, querying and analyzing data, identifying root causes, recommending and supporting decision making. The BA owns project goals by developing project plans, establishing deadlines, monitoring milestone completion, providing timely reporting of issues that impact progress and resolving conflicts. This includes documenting and prioritizing assignments. This is a fast-paced and rapidly growing environment.*This role is 100% temporarily remote due to COVID-19. After reopening of Healthfirst offices, this role will be a hybrid combination of on-site and remote locations*Duties and Responsibilities Include:Develop and maintain new and existing reporting tools, databases and processes.Analyze various types of data and processes in a versatile manner and present findings and recommendations in a professional manner.Query and manipulate data to root cause, trend, summarize findings and offer recommendations.Identify defects and improve departmental performance by supporting quality, operation efficiency and production goals thru reporting.Work departmentally and interdepartmentally to recommend and implement modifications to existing reporting functions.Report and present findings based on data analysis and other project assignments.Review technical specifications to ensure the department business requirements are adequately reflected in technical planning documents.Trend and compare analyses against departmental and corporate standards.Recommend changes to address deficiencies and/or further improve and streamline performance based on analysis findings.Recommend, develop and implement effective reporting tools for the department.Prepare routine reports as needed (financial, quality, production, operational efficiency, etc.).Proactively assist with identifying the training and development needs of the department staff.Track and report updates on individual work assignments and other projects within established timeframes.Work directly with appropriate members of the department and other Healthfirst business units to understand project concepts, objectives and approach.Assess and prepare to address the operational impacts, workflow, and training issues of the assigned project(s).Ensure post implementation accuracy.Provide project and informational updates to management as available and/or assigned.Collaborate with business units to understand strategic goals and promote an environment conducive to creativity, change and information exchange.Minimum Qualifications:Experience with in-depth data querying and manipulation of data to assist with root-causing, trending and summarization of projects presented to various level audiences.Experience with MS Excel functions that include working with large data sets, creating standardized reports (across multiple spreadsheets), utilizing advanced functions/formulas; creating, using and interpreting pivot tables, filtering and formatting.Experience gathering and communicating complex analytical business requirements in a simple and easy to understand manner to other staff. As the SME, the BA will need to effectively communicate with all levels of the organization, including technical staff, internal non-technical staff, testing teams, and business stakeholders.Experience in creating and running complex queries using SQL, AWS or other programs (i.e. Visual Basic coding, etc.)Bachelor's degree or equivalent working experiencePreferred Qualifications:Knowledge of Contact Center Operations processes, practices and relevant work experience within the healthcare industry (such as a managed care organization, commercial health insurance plans, hospital, etc.).Knowledge of Macess or other workflow systems (i.e. MS Project, SharePoint or any other time management system or project tracking tools).Experience with MS Access functions that include to running queries, Macros and building tables for reporting purposes.This is a collaborative team environment. You must be able to effectively work with others, provide and implement project solutions while understanding process flows.Demonstrate consistent multi-tasking skills and planning for prioritizing workload within tight deadlines.Compliance & Regulatory Responsibilities: NALicense/Certification: NAPlease note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Manager, Learning Delivery has responsibility for the management and execution of learning delivery for assigned business areas and establishes and/or leverages learning consistent with enterprise methodologies that effectively facilitate learning, development, and effectiveness. This role leads a team of Learning Delivery Specialists and partners with the Instructional Design group to provide oversight in the identification, development, delivery and maintenance of new and existing learning programs, solutions, interventions, and experiences for designated business unit functions. Serves as a consultative learning partner to supported business leaders to ensure learning is aligned to Healthfirst strategy and business unit objectives. Includes the assessment of needs, development of programs and curriculum, delivery of learning via appropriate modality (instructor-led classroom or webinar, online/digital eLearning, self-directed, or distance learning, etc.).Duties & Responsibilities: Actively manage a team of learning professionals and provide oversight in the content creation, facilitation, and delivery of learning across multiple operational areas and modalities. Provide developmental support and coaching to direct reports as well as training constituents.Provide leadership to a designated business unit area with a clear and well-planned learning strategy to meet business objectives, productivity, and efficiency goals. Manage resources and calendars to meet business outcomes. Develop functional professional relationships and strong partnerships with business areas to clearly understand their business, strategies, priorities, and challenges and foster an environment of teamwork and unity in driving towards the same goals and objectives. Provide consultative recommendations around performance and business actions related to learning and skill development to achieve results. Partner with Instructional Design group on the intake, needs analysis, design, and development to manage the delivery, measurement and ongoing maintenance of learning programs, curricula, and services to ensure alignment with the overall organizational direction. Partner closely with other learning team members to drive consistency and standardization in the learning experience throughout the enterprise. Plan and coordinate proper venues, timing, and modality (i.e. live classroom, webinar, self-guided, experiential and/or digital/e-Learning) of the required programs. Anticipate design/development or delivery challenges and work with business owners to identify mitigation strategies. Conduct external research and benchmarking to ensure best practice strategy in technology, tools, and approaches to learning delivery for increased effectiveness. Research and evaluate appropriate off-the-shelf or vendor training programs to meet select training needs. Ensure deliverables are timely, accurate, highly targeted, and meets the objective. Develop and implement survey, assessment, and measurement methods to accurately evaluate the effectiveness of technical and professional learning delivery and incorporate program changes resulting from findings.  Measures may include learner reaction, skill acquisition, on-the-job performance or behavior change, departmental output, effectiveness and/or business impact. Produce, analyze, and interpret reports on the progress of training programs and learning effectiveness and summarize and provide recommendations to leadership. Engage in feedback sessions and focus groups with the leadership and employees to enhance performance levels. Ensure effectiveness, timeliness, accuracy and relevance of training programs and their delivery. Ensure new hires are delivered to business owners on time and at appropriate knowledge/skill levels. Contribute to the overall success of the Learning Organization by identifying ways to continuously improve the learning process. Additional duties as assigned. Minimum Qualifications: Bachelor’s degree from an accredited institution. Previous work experience in a training or learning and development function with emphasis on managing standard operating procedure-based learning, guiding multiple systems technology instruction, and measuring/evaluating the effectiveness of a learning program and delivery. Creative and consultative approach to problem solving with exceptional consulting skills. Proven ability to quickly learn new business models, supporting technical infrastructure, business strategy, priorities, challenges and create highly targeted training needs analysis and training strategy while remaining flexible and adaptable to immediate and unexpected changes in plans. In-depth knowledge of training techniques and practices to drive the analysis, design, development, and delivery of enhanced skills to improve performance. Strong knowledge of learning and development methodologies; formal design and development approaches, adult learning best practices, industry training technologies used to deploy, maintain, and monitor learning. Experience with Learning Management Systems (LMS). Ability to communicate verbally and written in English with audiences at all levels. Ability to build strong partnerships and influence, motivate and educate senior leadership, peers, and stakeholders. Strong organizational planning, project management, communication, presentation, training, facilitation and influencing skills required. Ability to manage time effectively and exercise broad, independent, and good judgment and to effectively manage training programs, learning initiatives and skill/behavior development projects. Strong and creative people leadership skills with demonstrated ability for exceptional teamwork, negotiation, and change management. Must foster an environment that demands a high degree of teamwork and collaboration. Highly proficient with Microsoft Office software (Word, PowerPoint, Excel, Outlook) Must be able to identify and independently manage priorities and task assignments across multiple projects and groups. Ability to recognize that process effectiveness is not a one-time endeavor and that meaningful change requires continuous improvement. Flexibility to work extended shift hours to match the training needs of the business unit (may include shifts as early at 7:00am or as late as 8:00pm and/or weekends) Flexibility to travel out of state and/or internationally to company office locations, vendor sites and other work locations 25 - 50% of job requirement.  Preferred Qualifications: Master’s degree from an accredited institution with preferred focus area of study in Education, Business Administration, Healthcare Administration, Instructional Design, Instructional Technology, Learning and Development or related field in adult learning. Professional certification in one or more related learning, development, or performance improvement organizations: APTD or CPLP (Association for Talent Development), CPT (International Society for Performance Improvement) and/or Master Trainer (Langevin Learning Services). Ideal candidate will have 7-10 years of training experience ideally in a management capacity with deep experience with field sales. In-depth knowledge of training techniques and practices to drive the analysis, design, development, and delivery of enhanced skills to improve performance within sales teams. Experience using various LMS’, instructional design and e-learning authoring tools. Deploying a variety of solutions to geographically dispersed customers License/Certification: APTD, CPLP, CPT or Master Trainer  WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
Please note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.The Assistant Vice President, Clinical Design and Process Improvement is a thought leader on our approach to process improvement with the intent and purpose of better serving our members. He/she optimizes business processes across the Clinical department to ensure the successful operation and delivery of Healthfirst clinical services for federal, state, and commercial programs. He/she ensures emphasis on clinical program design, regulatory scope changes implementation (i.e., new population carve-ins, carve-outs, new LOB clinical services), execution, outcomes, continual improvement and performance enhancement with Healthfirst’s clinical business processes, performance and productivity measures. This role is instrumental in ensuring overall adherence to regulatory expectations while improving the overall quality and efficiency of our work output. The role requires cross-enterprise work to ensure department and corporate strategies are executed and achieved.·       Evaluates, develops and recommends strategic plans to coordinate with the future vision of Healthfirst business excellence and performance improvement approaches·       Establishes and communicates current and long-range department goals and objectives and monitors results on an ongoing basis, adjusting plans and performance expectations to achieve targeted performance improvement results·       Develops, formulates, recommends and implements decisions regarding policy, standards methods, procedures, clinical technology business requirements, and functions·       Ensures productivity meets or exceeds service and quality standards·       Identifies education opportunities and implements with training team and across the clinical organization ·       Ensures business excellence practices are in support of all NY state and federal compliance, audit and regulatory requirements, as applicable·       Utilizes extensive understanding of performance improvement metrics and best practices to lead the department·       Develops an effective team through hiring, training, coaching and providing ongoing and constructive feedback·       Builds, manages, develops and continuously improves the department to meet the diverse and dynamic needs of a growing, evolving organization.·       Conducts regular department/unit/office meetings to inform staff of performance, results and issues effective company·       Develops and manages department budget, including monitoring expenditures and reporting results·       Communicates results to executive leadership using standardized reports, dashboards and frequent verbal updates through participation in management meetings and operational review processes·       Stays current with technology, processes and best practices and leverage knowledge to identify opportunities for training and process improvement·       Performs other duties as necessary or assigned     WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Manager, Vendor Performance is responsible the direct and/or indirect management of all Healthfirst onshore and offshore delegated vendors. The team led by this manager is responsible for the successful onboarding, relationship management, and monitoring of delegated vendor performance by assuring adherence with Key Performance Indicators (KPIs), Service Level Agreements (SLAs), vendor compliance, and regulatory requirements.Duties & Responsibilities:Ensure successful onboarding and offboarding of Healthfirst delegated vendorsContinuously review and update vendor performance goals and expectationsMonitor and manages delivery of vendor services through periodic review meetingsLeverage delegated vendor scorecards with key stakeholders to objectively review vendor performance & address key concernsOversee day-to-day vendor relationship and performance tracking; Ensure all vendor performance issues are resolvedEnsure vendor performance variance and failed KPIs are documented and corrective action plans are implementedAssess and address risk and growth areas through the strategic management of vendor relationshipsEnsure timely completion and appropriate follow up on vendor desk auditsCommunicate delegated vendor results and collaborate with various departments to identify delegated vendor improvementsPrepare and conduct daily/weekly/monthly presentations to Senior Management on delegated vendor performance and resultsEngage in regular communication with delegated vendor performance support team to ensure production support activities being supported are in line with service level agreements and business needsDevelop an effective team through hiring, training, coaching, and providing ongoing and constructive feedbackConduct regular department/unit/office meetings to inform staff of performance, results and new changes or issues impacting the department and/or companyDemonstrate and maintain in-depth knowledge of the business success drivers, healthcare industry trends, and the competitive marketplace to provide measures and metrics to move the Healthfirst delegated vendor partner management department to a ‘Best-In-Class’ operation.Additional duties as assignedMinimum Qualifications:Bachelor's degree from an accredited institution or equivalent work experienceDelegated vendor management oversight work experienceExperience communicating and influencing impact and progress to senior leadershipDomestic and international travel may be requiredPreferred Qualifications: Expertise in healthcare operationsManagement experience in an operational department within the healthcare industry Experience developing strategy and processes for a department or functionExperience with Durable Medical Equipment DME is a plusPeople management experience and skillsCompliance & Regulatory Responsibilities: Noted aboveLicense/Certification: N/APlease note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.Minimum Qualifications:Bachelor's degree from an accredited institution or equivalent work experienceDelegated vendor management oversight work experienceExperience communicating and influencing impact and progress to senior leadershipDomestic and international travel may be requiredPreferred Qualifications: Expertise in healthcare operationsManagement experience in an operational department within the healthcare industry Experience developing strategy and processes for a department or functionExperience with Durable Medical Equipment DME is a plusPeople management experience and skillsCompliance & Regulatory Responsibilities: Noted aboveLicense/Certification: N/A
Healthfirst New York, NY
The Sr. Account Manager, Provider Complaints is an integral role that successfully manages escalated provider complaints as assigned. Reporting directly to the Sr. Manager, Complaint Resolution, they will be dedicated to (1) expediting the research of formally reported provider complaint (2) contacting providers to negotiate single case agreements and working through the various complaint details and (3) working with the appropriate internal stakeholders to close out all aspects of the complaints. In this role, the Sr. Account Manager, Provider Complaints deals with providers that require one-time resolution as well as serves as a single point of contact for Out of Network providers who have submitted a formal complaint. The Sr. Account Manager will drive results that increase provider satisfaction and reduce/eliminate repeat complaints from assigned providers. Efforts directly impact the improvement of CMS STAR ratings.Duties & Responsibilities: Serve as internal point of contact for cross-functional internal departments and teams to ensure all provider complaints are addressed and resolved within established guidelines  Partners with Sr. Complaint Analyst, and performs root cause analysis, to ensure effective identification of contributing complaint issues Performs all tracking and trending of activity on managing root cause inventory, as well as resolution of all root cause issues identifiedCommunicate complaint resolution results to key stakeholders Drafts complex complaint summaries and speaking points to ensure Regulatory can effectively respond to external agencies regarding all aspects of a complaint Makes recommendations on strategy and process improvement to drive successful outcomes of assigned complaints Negotiates complex single case agreements and settlements with complex providers as needed to resolve a complaint Works cross functionally to assist with resolution of complex claims related issues Tracks all aspects of provider complaints and ensures all assigned deadlines are met Serves as a subject matter expert for Delivery System Engagement on resolution of provider complaintsAdditional duties as assigned Minimum Qualifications: Network Management / Provider Relations experience with Hospital, Physician, Ancillary and/or Behavioral Health providers  Familiarity with reimbursement methodologies (DRG, FFS, Capitation, APG, APC) Experience with resolution of reported provider complaints Managed Care operations experience working with various business partners to facilitate resolution (Legal, Regulatory/Compliance, Claims) Resolution of root cause contributing to provider complaints Work experience with MS Excel, Word, Power Point Bachelor’s Degree from an accredited institution or equivalent work experience Preferred Qualifications: Cross functional experience in working as a liaison to internal business partners MS Visio Critical thinking skills Great attention to detail Master’s Degree from an accredited institution Compliance & Regulatory Responsibilities: Noted above Please note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Developer’s primary responsibilities are to analyze, design, implement and test customized software applications. The Developer will have a strong knowledge of software development and design and will have experience working to develop business-critical applications.The candidate will be responsible for capturing data requirements clearly and incorporating them into database schema and design. Will be working with stakeholders to understand the business processes, creating Informatica ETL workflows and rules to capture data from different sources and formats into the target. The ideal candidate will have excellent communication skills and can work with a broad variety of stakeholders including business, technical and Infrastructure team. Candidate should be able to investigate issues with the infrastructure and distil their findings to share with others. Candidate will be expected to become experts in specific Infrastructure tools across the enterprise.Duties & Responsibilities:Perform full stack design, development, and implementation of complex applications. Develop a deep understanding of the relationship between various business process, systems and the underlying data.Solve complex business rules by writing strong and efficient SQL queries, stored procedures, functions, and triggers.Optimally design and create database tables, views, stored procedures, use defined functions and other database objects.Monitor the performance, troubleshoot, and tune SQL queries and Informatica ETL processes.Design and develop Informatica ETL processes (mappings, queries, workflows, data objects) to support data loading and processing based on business rules. Work with different sources and formats (databases, XML, JSONS, Amazon S3, Messaging queues etc)Research and investigate any Informatica issues, ability to debug log files and issues relating to the system.Create and deploy builds on prem/Kubernetes cluster using CI/CD pipelines. Work with DevOps team to trigger pipelines using GitHub, Jenkins, Docker files/images, Jfrog Artifactory, ECR and Helm charts. Work with the team using Agile methodologiesMinimum Qualifications:7+ years of experience and proficiency with Relational Databases (Postgres, Oracle, SQL servers etc)5+ years’ experience working with Informatica Power Center or Informatica Cloud (Optional experience on Informatica Data Quality, Product 360/PIM, Power Exchange, MDM, Other BI tools)Experience with Continuous Integration/Deployment pipelines.Knowledge/Experience on Amazon Web Services and its different services (S3, EFS, EC2 instances).Excellent communication skills and ability to work independently and as part of a team with proven ability to influence with impact across functions and disciplines.Ability to manage multiple projects/deadlines, identifying the necessary steps and moving forward through completion.HS Diploma or GED from an accredited institutionPreferred Qualifications:Bachelors DegreeExperience with Web Services (REST, SOAP)Experience with any programming language (Java, Python, .Net, C# etc)Experience in Agile environments and methodologiesExperience with TruCare, Pega or MuleSoftFamiliarity with ServiceNowPlease note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Director of Product Shared Services serves as the overall subject matter expert for the development, implementation, and optimization of the Healthfirst product portfolio, including but not limited to Medicare, Medicaid, Integrated Products and Commercial insurance plans.The Director will serve as the key point of contact for enterprise projects dedicated to implementing new and modifying existing health insurance plans within the product portfolio. They will collaborate with leadership across the business to define and refine the execution strategy supporting product desired alterations alongside mandated changes from Centers for Medicare and Medicaid Services (CMS), NYS Department of Financial Services (DFS) and the NYS Department of Health (DOH)The individual is required to effectively operate and execute in a complex functional and matrix management structure. They will build strong working relationships across multiple operating units with oversight over a team that manages various projects which contribute significantly to the department and company’s strategic priorities centered on growth and engagement.Duties/ Responsibilities:Identify and lead initiatives related to ensuring that all operational areas are accurately and efficiently supporting the regulatory, compliance and business requirements specific to each productIdentify, coordinate, and implement efficiencies across business areas to improve products’ financial and operational performance and ensure compliance of product requirementsServe as subject matter experts related to the regulatory and business requirements for all products and provide support to Product Owners on key initiativesRepresent Product Management as subject matter expert for all external and internal audits as well as corrective action plansEnsure product integrity and support for clinical & medical managementMentor, coach, and provide support to a team of product management representativesCoordinate and organize work across multiple departments and functions within the companyMinimum Qualifications:BA/BS degree; over 5 years of experience; or any combination of education and experience that would provide an equivalent backgroundExposure to the healthcare industry and value-based careMust be able to successfully facilitate sound business objectives within highly regulated industryStrong public speaking and oral and written communication skills, with experience communicating complex messages to executive-level audiencesExperience leading teams, including both managers and individual contributors, to identify opportunities, develop plan of action, and executeAbility to coordinate and motivate people to achieve resultsAbility to train, coach and develop staff to accomplish established goalsKnowledge of current healthcare marketplace strategies and tools preferredKnowledge of insurance regulatory and contractual requirements preferredPreferred Qualifications:Leadership experience in the insurance industry, hospital/health system management and/or managed care/private network product management or equivalent in lieu of experienceMaster’s or a Professional degree MBA/MD/JD and or a Bachelor’s degree in communication, business management, healthcare management, health policy or related fieldExperience creating project plans and workflowsWE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Manager of Integrated Field Care Managers ensures prospective and active members are appropriately screened by Assessment Nurse team to meet enrollment and clinical eligibility requirements.Position may require supervisory field visits as needed.Duties and Responsibilities: Leads and manages daily Reassessment Nurse operations such as overseeing scheduling and staffing, providing clinical consultations, and ensuring departmental productivity goals are met in regards to quality, timeliness, accuracy, and consistency.Coordinates and communicates with Healthfirst Care Management teams regarding clinical eligibility issues, necessary service changes, and all other pertinent mattersCommunicates with Certified Home Health Agency  or other health care providers as needed.Communicates to family members/care takers, new enrollees, members and referral sources assessment outcomes. Exercises judgment within defined procedures and policies to determine appropriate actions and administers departmental policies.Develops and monitors team goals; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; and ensures an atmosphere of open communication, teamwork, and empowerment to make informed decisions   Assists Senior Managers in directing, training, and developing team members by embodying the Healthfirst Trailblazer mindset and leading others by example.Builds and develops relevant business relationships, critically thinks about departmental problems, and makes informed recommendations as to how to resolve issues. Additional duties as assigned.Minimum Qualifications:NYS RN License.US based field work experience of which at least one year is in the following areas: Geriatrics, Home Care, Discharge Planning, Case Management or Medical Surgical Nursing.In order to access the Uniform Assessment System (UAS), an unexpired NYS driver's license or NYS ID is required.  If residing outside of NYS, the candidate must be able to obtain a NYS ID before commencement of employment. Preferred Qualifications:  BA or BSNRelevant clinical experience such as previous care or utilization management, home care, or geriatricsKnowledge of Department of Health (DOH) and CMS regulations.Previous supervisory or training experienceWork experience with UAS/paperless database PHI systemsIntermediate Microsoft Word, Excel and PowerPoint skillsDemonstrated professionalism and leadership skills along with ability to develop, direct, and support a team Time management, critical/creative thinking, communication, and problem-solving skillsAdept at planning, organizing, and executingAbility to build and enhance team productivityAbility to allocate, monitor, and control resources while delegating and monitoring workloadsAbility to effectively manage performance as well as set and achieve goalsPlease note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Manager Provider Data Mnanagement functions as an advisor to a department, function, or organizational unit regarding duties, responsibilities, projects and/or activities. He/she is actively involved in daily operations of the Provider Data team only when required to meet schedules or resolve problems. His/her primary role is to implement and execute policies and to ensure that departmental priorities, schedules, and deliverables are attained.  This level typically has responsibility for budgeting, controlling costs, planning, scheduling, and procedural changes.  The Manager Provider Data Management embodies Healthfirst’s Culture Drivers through his/her workplace behavior, while promoting and reinforcing subordinate behavior that is consistent with Healthfirst’s desired culture.Manages inbound requests for Provider Operations tasks including the daily Intake of tasks received from Provider Network and ensures timely completion of those tasks with minimal re-work. Identifies opportunities for increased efficiency while maintaining high quality standards in alignment with company goals, regulatory compliance, and security requirements.  Establish clear and quantifiable policies & expectations for department Team Members related to productivity and quality of work in accordance with company goals and compliance requirements. Maintain visibility of daily production activities including volume of work, completion times, and quality of outcomes through Individual and aggregate Team Performance Reporting.Complete tasks and assignments on time and within established service level agreements. Meet with Team Members no less than monthly to discuss team performance and address trends requiring improvement.                  Recognize and reward employees for accomplishments and leverage performance improvement plans to ensure accountability as needed.          Collaborate with Stakeholders across the operations to implement process improvements across teams. Establish individual performance goals for all team members. Attend meetings and communicate relevant changes and updates as appropriate.      Hire, coach, and develop staff for advancement. Attend to any human resource related matters within area of responsibility by collaborating with Sr. Leadership, Employee Connect, and HRBP Collaborate with Operational Audit, Policy & Process Documentation, and Training Delivery Teams to ensure Job Aids, Training Materials and available tools and reference guides are aligned with the production environment and useful to team members.     Minimum Qualifications:   Moderate experience working with MS Office Suite to include adding/deleting rows/columns, creating simple formulas, creating standardized reports, and creating letters/memos. Experience reading and interpreting data, identifying trends, recommending proactive solutions, and effectively communicating them to senior management. Prior experience in a management role providing team leadership of exempt and non-exempt staff, including experience administering performance reviews, coaching, and disciplinary action, as well as conducting interviews, hiring, employee on-boarding, and terminations. Experience evaluating risk, making sound decisions, and solving problems quickly and effectively. Experience in an Operations area, managing high volume and complex repetitive tasks, in quality driven environment. Experience dynamically adjusting day to day operations and effectively leveraging resources to accommodate unexpected, time sensitive tasks. Previous experience managing competing priorities with effective communication. Associate Degree from an accredited institution or equivalent experience. HS Diploma or GED from accredited institution Preferred Qualifications: Knowledge of Medicare, Medicaid, Commercial and Consumer insurance guidelines Previous experience collaborating on cross-functional processes as a subject matter expert (SME) Experience working in health care industry specific to provider operations, including Provider Data Management, and/or Network Management. Experience with improving and automating manual processes to reduce completion time, while minimizing errors, eliminating rework, and meeting quality expectations. Experience in a Customer Service Environment with Internal and/or External business partners. Experience with MS Visio and Process Mapping. Basic understanding of Healthfirst systems such as MHS, Macess, Pega-Systems, and Tableau Software. Bachelor's degree from an accredited institution or equivalent experience.    Please note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.   
Healthfirst New York, NY
The Vice President - Clinical is responsible for providing the strategic guidance, direction and overall management of the Care Management function and processes across Healthfirst products. This position oversees efforts to improve member outcomes – in functional capability, health services utilization, quality of life, and other important outcomes as measured by external quality measurement programs. The VP seeks to improve the member experience with healthcare services and with the care management process. He/she provides leadership to manage administrative costs for his/her areas and uses data and metrics to drive constant process improvement.Sets the strategy, direction, and goals for all of the Management function with an eye towards quality of service, productivity and process improvement.Serves as the subject matter expert (SME) for care management contributing to interpretation and guidance for new and emerging rules and regulations at both the state and federal levelPartners with other clinical and operational leaders to drive consistency in process and member experience across Healthfirst departments. Uses internal and external benchmarks to drive high-quality outcomes and efficient processes.Actively participates in driving Quality and Population Health improvement efforts within care management teams and more broadly across the organization.Ensures compliance with all organizational policies, procedures and regulatory requirements on behalf of the Care Management function.Builds a high performing team that is organized and staffed effectively.Integrates the Care Management function into Utilization Management and other department workflows to support the coordination of care.Informs policy, product and process decisions across HF from the CM perspective.Additional duties as assignedMinimum Qualifications:A licensed Registered Nurse in New York or eligible10 years of experience within Care Management5 years of direct leadership experienceExperience within a Matrixed organizationPreferred Qualifications:BSNLeadership experience in Care ManagementWork experience providing mid to long-term strategic and tactical direction and operational oversight.Experience managing and developing large teams. Experience within realty-based leadership.Progressive leadership experience in a health care environmentKnowledge of Managed Long-Term Care, Medicare, and Mainstream Medicaid health-care regulations, legislation and lawsExceptional problem-solving; process-oriented yet flexibleDemonstrated ability to work independently and to manage multiple tasks and responsibilities.Excellent communication skills with the ability to effectively communicate to a wide range of audiences.Ability to work in a fast-paced environment and enhance team productivity.Experience working with clinical professionals (nurses, doctors, etc.)Experience in managed care or the healthcare industryNursing degree from an accredited program and New York State Registered Professional Nurse license.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Director of Behavioral Health Care Management is responsible for managing the behavioral health care of our members across all lines of business, including the physical and behavioral care management for HARP members in conjunction and in accordance with mandated State and/or Federal programs. This role will be instrumental in further advancing our whole person approach to care. The position will report up to the Vice President for Behavioral Health. The Director of BH Care Management will be responsible for identifying gaps and barriers in the delivery of the care management model and lead the implementation of agreed to solutions. S/he will leverage knowledge of data, systems, processes and programs to provide the operational oversight. Additionally, s/he will recommend, develop, implement and evaluate outcomes, objectives, policies and procedures related to the behavioral health management of our members and coordinate services with other departments and outside agencies.·       Provide leadership to ensure the provision of member centered care management with efficient and cost effective operations in conjunction with the VP, Behavioral Health and in collaboration with the Care Management- Behavioral Health leadership team.·       Provides oversight of and leadership to the Behavioral Health Care Management team including:o Driving initiatives and activities to ensure member care and service needs are in place. o Collaborating with other departments at Healthfirst to improve health outcomes and quality measure performance.o Continuously improving effectiveness and efficiency of processes and programs.o Providing information and knowledge to the primary care management staff, including new or changing processes and workflows based on Regulatory requirements and business needs. ·       Monitor the day-to-day operations of care management-BH to ensure smooth progress toward managing quality of care, adherence to compliance with standards and improving overall operations.·       Evaluate overall performance of the care management programs by gathering, analyzing and interpreting data and metrics.·       Create process and dashboards that represent improved clinical and business processes through analysis and collaboration with the care management leaders.·       Lead special projects and support clinical projects by ensuring all reports are completed timely and adhere to regulatory standards and HF policies and procedures.·       Collaborate with care management leaders to develop budget planning, preparation and adherence along with budget reforecasting.·       Participate and assist in long term business planning at the managerial and executive level for Behavioral Health.·       Collaborates with Clinical, BH Quality, and Population Health leadership to ensure the yearly quality goals are met through the implementation and direction of care management initiatives. ·       Coordinates and advises other stakeholders and business owners of CM initiatives.·       Evaluates departmental operations with a focus on process improvement.·       Works as a liaison with external organizations to assure lines of communication are in place for member engagement.·       Participates and represents Care Management on business implementation of new products·       Advocates for Plan public policy by actively participating as the clinical voice on various clinical committees and other clinical policy workgroups.·       Communicates with internal and external stakeholders in a variety of formats, both written (e.g., Word documents, Excel spreadsheets, PowerPoint presentations) and verbal.Minimum Qualifications:A Licensed New York State Social Worker, LMSW or LCSW, RN with Bachelor’s Degree from and accredited institution or other licensed mental health professional. Preferred Qualifications:Bachelor's degree in social work, nursing or other health care specialty.Experience in medical care management or social work with responsibility for direct reports, clinical services and administration.Experience recommending, developing, implementing and evaluating outcomes, objectives, policies and procedures related to care management performance and quality improvement.Experience developing work plans and organize work to successfully execute against timelines.  Communication with internal and external stakeholders in a variety of formats.Experience creating and editing documents using Microsoft Word.Experience manipulating data using Microsoft Excel.Demonstrated experience in creating and editing presentations in Microsoft PowerPoint.Ability to think strategically with strong collaboration skills to work effectively with a variety of external organizations and personnel.Ability to devise innovative and practical solutions to solve problems, experience with complex data systems.Expected to handle complex and confidential information in a secure, dependable and credible manner.Please note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Senior Medical Economics Analyst (Sr. MEA) provides support and consultation to the Medical Economics team within Finance through analyzing key business issues related to cost, utilization and revenue for multiple Healthfirst products. As the Sr. MEA, you will design and develop reports to monitor health plan performance and identify the root causes of medical cost trends. With those root causes identified, you will drive innovation by creating tools to monitor trend drivers and provide recommendations to senior leaders for affordability opportunities.Duties & Responsibilities:Analyze the financial performance of all Healthfirst products, identify favorable and unfavorable trends, develop recommendations to improve trends, communicate recommendations to managementLead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports.Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes.Provide data driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision making.Support Financial Analysis projects related to medical cost reduction initiatives.Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results.Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital performance.Minimum Qualifications:Must have a Bachelor’s degree from an accredited institution majoring in Math, Finance, Actuarial Science, Public Health or EconomicsAnalytical work experience within the healthcare industry (i.e. hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)Work experience with SAS and/or SQL where you have created queries, pulled large data sets and performed data manipulations/analysis.Work experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/formulas; creating, using and interpreting pivot tables, filtering and formatting.Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue.Basic understanding of Medicaid and Medicare programs or other healthcare plans.Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills.Preferred Qualifications:Strong project management experience and ability to handle multiple projects in a fast-paced environment.Experience in modeling financial impact of provider reimbursement changes.Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.Understanding of value-based risk arrangements.Experience using Tableau.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Commission Analyst will be responsible for the contract coordination of the entire appointment process including the customer service resource for external and internal insurance producers that market Healthfirst products.Coordination of contracts with external and internal producers |Oversight of the entire appointment process to ensure proper completion of contracts and marketing agreements for internal agents and commercial brokers/GA |Responsible for review of credentialing paperwork, confirmation of active licenses, and assignment of specific coding to be assigned to all new business for tracking and payment purposes |Assist in licensing issues, missing or disputed payments, and additional issues raised by brokers requiring resolution. |Conducts reviews of health & accident licenses received by external and internal brokers/agents on a regular basis and outreach to acquire updated licenses when applicable |Advises sales and marketing staff regarding producer problems and/or difficulties if outreach/education is required |Act as internal liaison and customer service resource for external and internal producers |Enrollment and policy questions |Systematic issues, for both internal and external |Coordination of fulfillment materials |Sales support and administrative services to non|employee selling producers |Responsible for market commission payments, research, and analysis |Responsible for incoming producer communications via phone, email, mail, and fax |Responsible for reporting and tracking sales and commission payments to the Sales department |Complete process reviews and implement improvements as needed |Assist in the creation of an FAQ and other helpful documentation for external producers as situations arise |Ensure that all commission plans are programmed and paid correctly, in a timely manner |Oversee process of providing timely and accurate responses to inquiries from all commissions payees |Analyze customer and associate enrollments and other source data to ensure smooth running of commissions based on these data sources |Analyze customer payments on a granular market level to ensure monthly commissions are paid accurately |Provide high quality, timely responses to management, fully meeting their informational and reporting needs |Create and maintain key commission analyses monthly, quarterly & annually |Strive for continual improvement, making the various commission processes as efficient as possible |Additional duties as assignedHS Diploma -Demonstrated knowledge of the broker distribution channel -Experience with resolving broker payout disputes -Proficient in Excel using Pivot Tables, Graphs and Charts -Excellent communication skills, especially in one-on-one and small group settings -Demonstrated interpersonal skills to consistently demonstrate job knowledge -Demonstrated ability to create and edit documents and presentations in MS Word, PowerPointPlease note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.HS Diploma -Demonstrated knowledge of the broker distribution channel -Experience with resolving broker payout disputes -Proficient in Excel using Pivot Tables, Graphs and Charts -Excellent communication skills, especially in one-on-one and small group settings -Demonstrated interpersonal skills to consistently demonstrate job knowledge -Demonstrated ability to create and edit documents and presentations in MS Word, PowerPoint
Healthfirst New York, NY
The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services. A&G works in collaboration with divisions within and outside the organization to resolve issues in a timely and compliant manner. The A&G Specialist is the subject matter expert responsible for non-clinical case development and case resolution while ensuring compliance with Federal and/or State regulations. The A&G Specialist will manage his/her own caseload and is accountable for investigating and resolving member or provider initiated cases. Manages all Department of Health (DOH) and executive complaints as needed. The incumbent may also handle non-clinical claim appeals that come from Healthfirst participating and non-participating providers. This is full-time on-site position located at either the 100 Church Street location in New York City or the 1101 Greenwood Avenue location, Lake Mary, Florida. This position may require attendance at A&G/ Operations divisional meetings and Town Halls, some of which may require travel to one of the locations (T&E will be covered according to policy).Duties and ResponsibilitiesResponsible for case development and resolution of non-clinical cases, such as: certain types of claim denials, member complaints, and member and provider appeals.  The end-to-end process requires the Specialist to independently:Research issuesReference and understand HF’s internal health plans’ policies and procedures to frame decisionsInterpret regulationsResolve cases and make critical decisionsEdit and finalize resolution lettersManage all duties within regulatory time-framesCommunicate effectively to hand-off or pick-up work from colleaguesWork within a framework that measures productivity and quality for each Specialist against expectationsAdditional duties as assignedMinimum QualificationsBachelor’s degree from an accredited institution or relevant work experiencePreferred QualificationsMinimum of two (2) years of work experience in Managed Care or Health InsuranceWork experience in claims, customer service, home health, hospital or doctor’s office preferredExperience working in care management systems, such as CCMS, TruCare or HylandDemonstrated critical thinking and decision-making competenciesHighly effective communication, organizational, and customer service skillsDemonstrated ability to be detail oriented, work under pressure, manage tight timeframesPlease note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Campaign Manager candidate has extensive experience managing email execution process and comprehensive functional knowledge of the Salesforce Marketing Cloud platform. This individual will develop and manage the workflow of all multi-channel campaigns both operational and transactional. Additional responsibilities include implementation and ongoing management of operational processes and tasks in support of lead generation / lead nurturing programs, retention campaigns. This person will work to create standardized, repeatable processes that ensure best practices are used when developing campaigns in marketing cloud.The candidate must be able to lead requirement gathering sessions and manage campaign and project timelines. The candidate must also be able to manage stake holders’ expectations and scope by working closely with stakeholders and other internal teams as appropriate.Primarily responsible for design, develop and execution of email, SMS, and Push communications from end-to-end. Drive the campaigns through acquisition, retention, transactional, and Onboarding initiatives. Refine campaign strategies and offer marketing advice and suggestions on campaigns.Ability to innovate and drive efficiencies that increases member impact Excellent project management skills. Ability to manage both creative requirements and operational needs. Conceptualize and initiate tests to continually improve key metrics across communication programs. Develop responsive email templates for current and future initiatives. Identify and deliver process improvements to optimize campaign management process.Minimum RequirementsBachelor’s degree or equivalent education and related experience 4+ years’ experience across any of the following roles: campaign manager, email developer or Salesforce Marketing Cloud Developer. 3+ years of experience with Salesforce Marketing Cloud (ExactTarget) including Journey Builder journey creation, Salesforce Marketing Cloud Connect integration management, Data Extensions, Cloud Pages and Automation2+ years’ experience documenting business problems requirements.Certifications (at least one of): SFMC Email Specialist, SFMC Developer, SFMC ConsultantExperience analyzing and reporting on campaign performance and using A/B/N testing to continuously improve sales and engagement objectives.Excellent in HTML/CSS/JavaScriptAMPScript proficiency, preferredExcellent Analytical skills Flexible, organized, and precise Collaborative / Team player Ability to grow and take on additional duties and responsibilities Highly detail-oriented, with excellent time management, prioritization and organization skills Strong communication skills: ability to communicate effectively with CRM project stakeholdersPlease note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.
Healthfirst New York, NY
The Assistant Vice President (AVP) Provider Engagement is a key role responsible for advancing Healthfirst's interests in Core New York Markets (5 boroughs and Long Island). The primary goal is to leverage improved alignment with our partners to drive membership growth, improve the quality of member health outcomes and access to care while, optimally, managing financial performance. This role will help establish Healthfirst as the pre-eminent plan through execution of key corporate strategies to expand HF’s market share in the territories where we currently operate. The AVP will develop internal and external partner relationships and align initiatives across organizations to facilitate the development of an optimally functioning delivery system through value-based payments. The AVP of Provider Engagement will serve as the interface between Healthfirst and the network in Core Markets with the objective of providing exceptional engagement experience. This role is responsible for contract development, negotiations, pricing and management.Leverage a deep understanding of Healthfirst’s technology, reporting services, and other capabilities combined with up-to-date knowledge of providers’ business models and objectives to ensure strategic alignment and overall provider satisfactionServe as a thought leader for our partners, the AVP will bring Healthfirst’s current and potential value-adds to our partners in a thoughtful and professional manner to yield greater efficiencies and stronger aligned strategic relationshipsManage and develop a strong team that drives initiatives aligned to HF’s four core principles: Quality, Clinical Efficiency, Administrative Efficiency and Population HealthBe accountable for hospital and physician network development and management through customer-focused leadership and team developmentCollaborate with Vice President of Network Management and with HF senior leadership to represent the department, propose solutions and make decisions in the best interest of Healthfirst on corporate projects and initiativesPlan, develop and implement Provider Engagement and other corporate strategies which promote a positive provider experience with Healthfirst, through administrative ease, accurate and timely payments, educational support, clinical support, and aligned goalsBuild, maintain, and inform an in-depth knowledge of all Healthfirst’s Business Transformation solutions and how they align with our partners’ strategiesBuild strategic account plans to support our Provider partners utilizing Healthfirst tools and available resources to enhance collaboration, increase efficiency, improve services, thereby exploiting HF’s competitive advantage.Work with providers to explain and promote partnerships to build credibility and confidence in our services and capabilitiesIdentify key staff talent and develop a retention and promotion program through coaching and mentoringRequirements:The AVP will be a highly motivated, strategy-oriented individual who is excited to grow and cultivate partnerships that are mutually beneficialExecutive presence, an enterprise mindset, and the ability to lead cross-functional, matrixed, and high-performing teams are a must10 or more years of experience in the healthcare industry focused on physician, provider, and/or hospital engagement roleAbility Exceptional influencing and problem-solving skills to coalesce various internal stakeholder departments and functions in the adoption of a new operating modelDemonstrated ability to manage complexity and ambiguityExperience creating dashboards, reporting metrics, synthesizing and delivering key information through organizationsExcellent presentation skills with experience presenting to executive audiencesStrong knowledge of healthcare regulations and complianceAbility to effectively drive changeExperience managing large cross-functional and matrixed teamsStrong written and verbal communication skills, as well as the ability to effectively present ideas and build consensus with stakeholdersBachelor’s DegreeHighly Preferred QualificationsMaster’s degree in healthcare administration, public health, business, economics, or other related fieldExperience with Change Management approachesTravelThis position may require some local travel.Please note: Since we care so greatly about our employees' and members' wellbeing, Healthfirst is moving to a fully vaccinated in-office environment. You must be vaccinated to work in our offices, even if you are partially remote. If you are selected to interview for this role, we will explain our vaccination policy and ensure you are comfortable moving forward with further interviews based on your work location.WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and SupplementAll hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.Requirements:The AVP will be a highly motivated, strategy-oriented individual who is excited to grow and cultivate partnerships that are mutually beneficialExecutive presence, an enterprise mindset, and the ability to lead cross-functional, matrixed, and high-performing teams are a must10 or more years of experience in the healthcare industry focused on physician, provider, and/or hospital engagement roleAbility Exceptional influencing and problem-solving skills to coalesce various internal stakeholder departments and functions in the adoption of a new operating modelDemonstrated ability to manage complexity and ambiguityExperience creating dashboards, reporting metrics, synthesizing and delivering key information through organizationsExcellent presentation skills with experience presenting to executive audiencesStrong knowledge of healthcare regulations and complianceAbility to effectively drive changeExperience managing large cross-functional and matrixed teamsStrong written and verbal communication skills, as well as the ability to effectively present ideas and build consensus with stakeholdersBachelor’s DegreeHighly Preferred QualificationsMaster’s degree in healthcare administration, public health, business, economics, or other related fieldExperience with Change Management approachesTravelThis position may require some local travel.