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The Case Manager coordinates care plans for assigned members, manages pre-certification and concurrent reviews, and ensures optimal health outcomes. Responsibilities include conducting assessments, collaborating with healthcare providers, documenting interventions, advocating for member services, and monitoring performance metrics.
The VP, Data Product Librarian at Healthfirst will develop and lead the Data Strategy and manage a team focused on Data Architecture and Governance. Responsibilities include providing thought leadership across IT and business units, managing budgets, and fostering cross-functional partnerships to optimize Data Product performance.
The Senior Product Specialist leads product optimization initiatives, collaborates with cross-functional teams, and ensures successful execution of projects. Responsibilities include monitoring activities, communication across departments, and acting as a subject matter expert on product requirements. This role involves adapting to changes and managing multiple priorities effectively.
The Senior Manager of OD & Employee Experience will lead efforts to enhance employee experience across Healthfirst by designing tools and processes to understand employee needs, developing action plans for improvement, and leading initiatives that enhance organizational effectiveness. Collaborating with HR and various stakeholders, the role focuses on operationalizing ideas, measuring impacts, and maintaining current knowledge of industry innovations.
The Manager of Product Management and Strategy leads cross-functional efforts to enhance market growth strategies for the senior market portfolio. Responsibilities include analyzing membership experience, managing competitive intelligence, optimizing revenue opportunities, and ensuring alignment with regulatory changes. The role requires collaboration with finance, sales, and marketing to derive actionable growth and retention plans, backed by effective communication and reporting on program success.
The Strategic Account Management Associate coordinates activities for a cross-functional team of hospital account managers, documents workflow changes, conducts research and reporting, and ensures effective communication among teams. This role involves learning about the Healthfirst business and supports project implementations while working closely with various departmental partners.
The Coding Educator oversees and educates providers on proper coding practices to ensure compliance with CMS and ICD10 CM guidelines. Responsibilities include auditing clinical documentation, responding to provider inquiries, conducting training sessions, creating educational materials, and managing coding accuracy audits.
The Manager of Network Account Management will lead a team to develop and manage provider relationships, enhance quality and drive membership growth. Responsibilities include strategic planning, negotiating agreements, and collaborating with internal stakeholders to achieve business goals.
The Manager, Enrollment & Billing oversees enrollment and billing operations at Healthfirst, ensuring operational efficiency, accuracy, and compliance with policies. They are responsible for managing team performance, resolving issues through cross-functional collaboration, and implementing processes to ensure payment integrity. The role includes monitoring productivity, employee development, and achieving departmental goals.
The Senior Manager of Audit & Compliance Analytics leads analytics efforts to support Compliance and Internal Audit teams. This role develops strategies for high-priority analytics, manages stakeholder needs, oversees implementation of analytics solutions, and presents findings to various stakeholders, driving data-informed decision-making.
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