Top 115 Healthfirst Jobs

Appeals & Grievances Clinical Specialist
Healthfirst —Remote
- $83,100 - $120,360 a year
- Full-time
- Mid-level
- Data entry
- Nursing
- Health insurance
- Dental insurance
Care Coordinator
Healthfirst —Remote
- $48,600 - $65,960 a year
- Full-time
- Writing skills
- High school diploma or GED
- Associate's degree
- Health insurance
- Dental insurance
Dental Hygienist
Healthfirst Bluegrass —Lexington, KY
- $35 - $37 an hour
- Part-time
- CPR Certification
- Dental office
- BLS Certification
- Paid holidays
- Loan repayment program
Quick Apply
Peer Support Specialist
Healthfirst —New York, NY
- $34,900 - $54,080 a year
- Overtime
- Spanish
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Family or Internal Medicine Physician
HealthFirst Family Care Center, Inc. —Fall River, MA
- $226,600 - $257,500 a year
- Internal Medicine
- Adults
- Mid-level
- Paid holidays
- Loan repayment program
Quick Apply
Chiropractor
HealthFirst Chiropractic —Britton, SD
- $100,000 - $120,000 a year
- Full-time
- Private practice
- Mid-level
- Driver's License
- Relocation assistance
- Health insurance
Quick Apply
1d
Dental Assistant Supervisor - $2,000 Signing Bonus!
HealthFirst Family Care Center, Inc. —Fall River, MA
- $29.65 - $33.56 an hour
- Evening shift
- Spanish
- Dental office
- Customer service
- Continuing education credits
- Paid holidays
Quick Apply
Dental Assistant (EDDA): NEW PAY RATE and SIGN ON BONUS!
Healthfirst Bluegrass —Lexington, KY
- $24 an hour
- Full-time
- CPR Certification
- Dental office
- Mid-level
- Paid holidays
- Disability insurance
Quick Apply
Senior Manager Clinical Eligibility
Healthfirst —New York, NY
- $105,100 - $188,020 a year
- Full-time
- Spanish
- Nursing
- Microsoft Excel
- Health insurance
- Dental insurance
Director Configuration, Benefit Administration
Healthfirst —New York, NY
- $127,500 - $236,555 a year
- Full-time
- Office
- High school diploma or GED
- Analysis skills
- Health insurance
- Dental insurance
Field Assessment Registered Nurse, Bronx, NY - $10,000 Sign-On Bonus (Spanish)
Healthfirst —New York State
- $73,400 - $120,360 a year
- Full-time
- Microsoft Word
- Spanish
- Microsoft Excel
- Health insurance
- Dental insurance
2d
Field Assessment Registered Nurse, Bronx, NY - $10,000 Sign-On Bonus (Spanish)
Healthfirst —New York State
- $73,400 - $120,360 a year
- Full-time
- Microsoft Word
- Spanish
- Microsoft Excel
- Health insurance
- Dental insurance
Application Developer/Manager, Digital Provider Collaboration Program
Healthfirst —Remote
- $134,600 - $194,480 a year
- Online Application
- Computer Science
- Mid-level
- SQL
- Health insurance
- Dental insurance
Manager, Medicaid Strategic Initiatives
Healthfirst —New York, NY
- $88,700 - $149,430 a year
- Full-time
- Microsoft Excel
- Public speaking
- Bachelor's degree
- Health insurance
- Dental insurance
Senior Manager, HRBP - IT | Hybrid NY
Healthfirst —New York, NY
- $105,100 - $188,020 a year
- Full-time
- Hybrid work
- Data analysis skills
- Office
- Bachelor's degree
- Health insurance
- Dental insurance
Director, Workforce Analytics and Strategy - Hybrid NY
Healthfirst —New York, NY
- $127,500 - $236,555 a year
- Full-time
- 7 years
- Office
- Master's degree
- Health insurance
- Dental insurance
Senior Manager, Benefits | Hybrid NY
Healthfirst —New York, NY
- $105,100 - $188,020 a year
- Full-time
- Hybrid work
- 5 years
- HIPAA
- Office
- Wellness program
- Health insurance
Technical Product Manager, Production Support
Healthfirst —Lake Mary, FL
- $119,600 - $194,480 a year
- Full-time
- Computer Science
- SQL
- Supervising experience
- Health insurance
- Dental insurance
Hybrid Assessment Registered Nurse, Bronx, NY- $7,500 Sign-On Bonus (Spanish)
Healthfirst —New York, NY
- $83,100 - $120,360 a year
- Full-time
- Remote
- Microsoft Word
- Spanish
- Microsoft Excel
- Health insurance
- Dental insurance
Medical Call Center Rep
HealthFirst Family Care Center, Inc. —Fall River, MA
- $20.50 - $23.50 an hour
- Full-time
- Spanish
- English
- High school diploma or GED
- Continuing education credits
- Paid holidays
Quick Apply

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Appeals & Grievances Clinical Specialist

Healthfirst -
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Job Details

Full-time
$83,100 - $120,360 a year

Benefits

Health insurance
Dental insurance
401(k)
Vision insurance
Life insurance

Qualifications

Nursing

Full Job Description

Position Summary: The Appeals & Grievances Clinical Specialist is responsible for receiving, investigating and responding verbally and in writing to member and provider clinical appeals and grievances.

Duties and Responsibilities:

Ensures that appeals and grievances are properly classified (e.g. denial of service, denial of payment, or a grievance about a provider)
Processes appeals and grievances in accordance with internal company policy
Enters data into appropriate medical management services
Collaborates with other departments to thoroughly investigate appeal and grievances.
Prepares for and participates in regulatory site visits.
Additional duties as assigned.

Minimum Qualifications:

RN
Preferred Qualifications:

Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management.
Understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual or Medicare Guidelines.
Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as corporate email and virtual filing system. (ie. Macess).
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360
All Other Locations (within approved locations): $73,400 - $108,160

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

73400-108160

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Refine Your Search

Healthfirst jobs

Appeals & Grievances Clinical Specialist

Care Coordinator

Dental Hygienist

Peer Support Specialist

Family or Internal Medicine Physician

Chiropractor

Dental Assistant Supervisor - $2,000 Signing Bonus!

Dental Assistant (EDDA): NEW PAY RATE and SIGN ON BONUS!

Senior Manager Clinical Eligibility

Director Configuration, Benefit Administration

Field Assessment Registered Nurse, Bronx, NY - $10,000 Sign-On Bonus (Spanish)

Field Assessment Registered Nurse, Bronx, NY - $10,000 Sign-On Bonus (Spanish)

Application Developer/Manager, Digital Provider Collaboration Program

Manager, Medicaid Strategic Initiatives

Senior Manager, HRBP - IT | Hybrid NY

Director, Workforce Analytics and Strategy - Hybrid NY

Senior Manager, Benefits | Hybrid NY

Technical Product Manager, Production Support

Hybrid Assessment Registered Nurse, Bronx, NY- $7,500 Sign-On Bonus (Spanish)

Medical Call Center Rep

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