- Healthfirst (GA)
- …Meet SLA guidelines in creating files, reconciling information, executing system batches, etc. Analyze business processes, identify root causes and provide data-based ... insights and recommendations for process improvements Access and analyze data across multiple systems to identify areas of risk, complete root cause analysis to determine key drivers and develop recommendations to mitigate, report findings and recommendations… more
- Healthfirst (FL)
- …Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. Conducts assessments to identify barriers and ... opportunities for intervention. Develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals. Generates referrals to providers, community-based resources, and appropriate services and other… more
- Healthfirst (FL)
- …Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. Conducts assessments to identify barriers and ... opportunities for intervention. Develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals. Generates referrals to providers, community-based resources, and appropriate services and other… more
- Healthfirst (NY)
- **Duties & Responsibilities:** + Works collaboratively to design and manage the Healthfirst Pharmacy Benefits for all Healthfirst plans. + Collaborates with ... and Actuary to analyze, interpret, and manage pharmacy cost trends for all Healthfirst plans + Provides support and/or oversight for all clinical and operational… more
- Healthfirst (NY)
- …+ Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued ... Stay, Reduction, Termination, and Suspension of services. The end to end process requires the Specialist to independently: + Research issues + Reference and understand HFs internal health plans policies and procedures to frame decisions + Interpret regulations… more
- Healthfirst (CT)
- …roles, people leader roles, business analytics, workforce effectiveness and other areas. Healthfirst is committed to the well-being of its employees, offering an ... & Accident Insurance, Flexible Reimbursement Accounts, Employee Assistance Plan, Healthfirst 401(k) plan, and much more. Should you join...Agent Class. Thank you for considering a career with Healthfirst . We look forward to the possibility of you… more
- Healthfirst (NY)
- …with team members and other stakeholders. Effectively communicate program expectations to Healthfirst and vendor stakeholders in a timely and clear fashion. + Act ... managing regular QA processes related to communications sent on Healthfirst 's behalf to member and providers, as well as...as facilitating scheduled or ad hoc audits done by Healthfirst or other external experts. Develop and maintain … more
- Healthfirst (NY)
- …improvement, prioritizing projects, and building critical relationships with other Healthfirst departments Builds sustainable relationships of trust through open and ... interactive communication with internal and external customers Additional duties as assigned Minimum Qualifications: HS diploma or GED Working experience in a fast-paced environment Proficient in Microsoft Office Suite applications including Excel, Word, and… more
- Healthfirst (NY)
- …+ Utilize established workflows and procedures for multistate payroll operations. Ensure compliance and accuracy of payroll tax processing + Reconciliation and ... analysis of tax data + Preparation of tax funding where required + Identification and/or resolution of payroll issues as they arise + Verify system tax calculations, and update tax rates in Workday as required + Research and resolve assigned payroll tax… more
- Healthfirst (NY)
- …Understand claim payments and impact of fee-schedule updates from State/CMS. Assist and monitor direct payment initiatives from the state for Provider Organizations ... Responsible for contract analysis and fee schedule modeling. Maintain current project logs and work plans on assignments. Create and maintain database for fee schedules changes. Collaborate and Coordinate with teams in Finance for all the planned projects for… more
- Healthfirst (NY)
- …teams to relink cases that have active coverage but are not linked to Healthfirst plans in the system by providing proof of services. Assist the Disenrollment team ... in reviewing all membership that has inactive Medicaid coverage by assisgning case to be worked on by the Entitlement Advocate team and following up on them weekly until they are Eligible/active. Has full and complete access to patient records and reports as… more
- Healthfirst (Enfield, NY)
- …home visits per day (clustered in small geographic areas) Supports the Healthfirst clinical team members, including UAS nurses and Care Managers, by facilitating ... needed, escalates member questions, as directed Properly documents findings in Healthfirst information systems Collaborates with other members of the clinical team… more
- Healthfirst (NY)
- …Scope, plan, and oversee project tasks, timelines, deliverables, and the internal and external people engaged in multiple projects Works in deep partnership and daily ... collaboration with the OD program or project lead ensuring an agreed upon, timely, flawless delivery Coordination of a variety of tasks which make enterprise-wide employee development programs run flawlessly, such as building and managing rosters, scheduling… more
- Healthfirst (NJ)
- …Conduct outreaches for newly enrolled members to review current and approved services, durable medical equipment (DME) and additional requests Review intake documents ... for pre-approved services and escalate discrepancies as needed Complete Welcome Onboarding and Consumer Directed Personal Assistant Assessments and identify any issues or risk factors that require clinical escalations to a CM/PCM. Initiate and finalize… more
- Healthfirst (NY)
- …Manages designated caseload of members who could benefit from Peer Support services, care coordination, and health navigation Schedules and conducts multiple ... field-based visits per day (clustered by geographic areas) Completes assessments and questionnaires to identify barriers and opportunities for intervention Works telephonically when not in the field to make outreach calls and receive incoming calls to/from… more
- Healthfirst (NY)
- …Communicates with regulatory agencies and other external organizations Ensures that Healthfirst meets requirements for all lines of business by developing ... and maintains departmental work plans and policies & procedures to ensure Healthfirst meets all regulatory requirements Supervises the performance of direct reports… more
- Healthfirst (NY)
- …Associates Degree or equivalent experience (preferably in Healthcare industry) Strong planning, organizing, and execution skills - experience managing a range of ... concurrent large scope projects Ability to craft communications, set meetings and organize schedules in Microsoft Outlook Ability to communicate effectively verbally and in writing Ability to establish and maintain relationships with key stakeholders Advanced… more
- Healthfirst (NY)
- …of a clinician (Care Manager/ Case Manager/ Clinical Specialist) Assists the clinicians by walking the virtual floor and assisting Managers in resolving inquiries. ... Assists the Manager in monitoring logs of open/closed cases to ensure all are handled appropriately and in a timely manner. Takes responsibility for complex cases. Collaborates with the team to provide input on training to new clinicians. Handles a caseload… more
- Healthfirst (FL)
- …Provides strategic architectural guidance to business domains in defining, and designing enabling technologies supporting business capabilities and processes, as well ... as in researching, identifying and internally marketing technology enablers supporting enterprise initiatives. Partners with business stakeholders, delivery programs leaders to identify and deliver architectural runway enablement for modern, cost-effective,… more
- Healthfirst (TX)
- …Business lead for external and internal regulatory reporting, surveys, audits, and investigations impacting dental operations In partnership with the business and key ... partners, continuously drive a strong culture of compliance Directs, investigates, and resolves regulatory compliance concerns Ensures compliance with existing and new rules, regulations, and revisions, as set forth by federal and state law Identifies… more
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