The specialist is responsible for investigating and responding to clinical appeals and grievances from members and providers. This includes classifying cases, collaborating with other departments, and participating in regulatory site visits.
HealthFirst
12 Remote Job Openings at HealthFirst
Vendor Partner Specialist - Contact Center Operations
HealthFirst
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Full Time
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5 days ago
HealthFirst
The Vendor Partner Specialist manages relationships with external vendors to ensure service level agreement adherence and quality auditing. They act as a liaison between department leaders and vendors to coordinate workflow, training, and process improvements.
The Support Coordinator assists care managers with non-clinical tasks, including managing authorizations, creating cases, and conducting telephonic outreach. They serve as a primary point of contact for members and providers to coordinate care and ensure timely resolution of issues.
Bilingual Call Center Rep (Relationship Coordinator)
HealthFirst
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Full Time
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7 days ago
HealthFirst
The Relationship Coordinator handles inbound and outbound calls to educate prospective members on Long-Term Care enrollment and Medicare Advantage plans. They are responsible for managing leads in Salesforce, scheduling appointments for clinical staff, and meeting growth quotas.
Bilingual Sales Operations Service Agent (Spanish and/or Mandarin/Cantonese
HealthFirst
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Full Time
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12 days ago
HealthFirst
Provide high-quality telephone and written support to brokers, agents, and their uplines regarding eligibility, benefits, and commissions. Collaborate with management and quality assurance teams to resolve service issues and improve operational processes.
Lead the strategy and operational excellence of public and private cloud infrastructure through automation and orchestration. Mentor other engineers and establish governance standards to ensure reliable, secure, and repeatable service delivery.
Application Developer/Manager, Digital Provider Collaboration Program
HealthFirst
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Full Time
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13 days ago
HealthFirst
Lead the design, implementation, and delivery of business-critical healthcare applications using Qlik technology. Responsibilities include creating complex dashboards, automating business processes, and collaborating with stakeholders to define system requirements.
The Clinical Pharmacist supports quality measures for Essential Plan and Medicare populations through provider and member outreach to address gaps in care. They ensure clinical recommendations align with current guidelines and maintain compliance with State and Federal agencies.
The Service Agent supports Contact Center Operations by addressing member and provider inquiries and resolving complaints across various lines of business. They are responsible for maintaining high customer experience standards, preventing dis-enrollments, and ensuring HIPAA compliance.
The Manager of Clinical Appeals and Grievances leads a team to standardize processes, ensure regulatory compliance, and optimize clinical appeal workflows. This role involves strategic decision-making, vendor oversight, and collaborating with leadership to meet production and quality targets.
The Medical Peer Reviewer consults on medical necessity within utilization management, ensuring adherence to internal and external regulations by assessing authorization requests and claims payments based on medical records. This role involves rendering determinations within regulatory timeframes, maintaining productivity standards, and collaborating across various medical and management departments.
The Clinical Pharmacist supports quality measures for Essential Plan and Medicare populations through provider and member outreach. They also ensure compliance with Federal and State regulations while collaborating with various internal teams.
