Top 114 Healthfirst Jobs

Medical Peer Reviewer
Healthfirst —Remote
- $122,907 - $188,020 a year
- 8 hour shift
- Medicine
- Mid-level
- Communication skills
- Paid holidays
- Health insurance
Support Coordinator
Healthfirst —Remote
- $34,900 - $54,570 a year
- Full-time
- Spanish
- Microsoft Outlook
- HIPAA
- Health insurance
- Dental insurance
11d
Psychiatric Mental Health Nurse Practitioner - with Substance Use Disorder Treatment
HealthFirst Family Care Center Inc. —Laconia, NH
- Full-time
- Nursing
- Psychiatry
- Adults
- Health insurance
- Dental insurance
Quick Apply
Nurse - Primary Care - Monday - Friday. 4 days on-site, 1 day remote
HealthFirst Family Care Center Inc. —Laconia, NH
- $32 - $40 an hour
- Full-time
- Hybrid work
- Nursing
- Patient monitoring
- RN License
- 403(b) matching
- Loan repayment program
Quick Apply
7d
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
Peer Support Specialist
Healthfirst —New York, NY
- $34,900 - $54,080 a year
- Overtime
- Spanish
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Chiropractor
HealthFirst Chiropractic —Sisseton, SD
- $100,000 - $120,000 a year
- Full-time
- Private practice
- Mid-level
- Driver's License
- Relocation assistance
- Health insurance
Quick Apply
1d
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
12d
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
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
Bilingual Patient Services Specialist
Healthfirst Bluegrass —Lexington, KY
- $16.20 an hour
- Full-time
- Spanish
- HIPAA
- English
Quick Apply
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
Dental Assistant Paid Training Opportunity
HealthFirst Family Care Center, Inc. —Fall River, MA
- $18 an hour
- Full-time
- 18 years or older
- Dental office
- Computer literacy
- Paid training
Quick Apply
Actuarial Analyst
Healthfirst —New York, NY
- $68,900 - $99,620 a year
- Full-time
- Mid-level
- Office
- Finance
- Health insurance
- Dental insurance
Dental Patient Service Rep (part-time)
HealthFirst Family Care Center, Inc. —Fall River, MA
- $20.50 - $23.50 an hour
- 8 hour shift
- Spanish
- Dental office
- Customer service
- Continuing education credits
- Paid holidays
Quick Apply
Utilization Management Manager
Healthfirst —New York, NY
- $99,700 - $168,810 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
APRN or Physician Assistant
Healthfirst Bluegrass —Lexington, KY
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid holidays
- Loan repayment program
Quick Apply
Team Lead Enrollment and Billing
Healthfirst —Lake Mary, FL
- $68,900 - $99,620 a year
- Full-time
- Microsoft Word
- Mid-level
- High school diploma or GED
- Health insurance
- Dental insurance
Ancillary Network Account Manager
Healthfirst —New York, NY
- $68,900 - $99,620 a year
- Full-time
- Research
- High school diploma or GED
- Analysis skills
- Health insurance
- Dental insurance

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Medical Peer Reviewer

Healthfirst -
Remote

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Job Details

Part-time
$122,907 - $188,020 a year

Benefits

Paid holidays
Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Life insurance

Qualifications

Medical License

Full Job Description

Job Profile Summary A vital role of the CMO Administration team, the Medical Peer Reviewer plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to internal Healthfirst and external regulations.

Duties/Responsibilities:

The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations.
The Medical Peer Reviewer will render determinations in the format and within timeframes to follow Regulatory and Operational policies.
The Medical Peer Reviewer will:
Maintain productivity standards.
Collaborate with Utilization Management and Care Management and medical departments as needed, reviews and manages cases/caseload from multiple lines of businesses
Demonstrate the ability to be flexible when case load volume fluxes and when Leadership requests changes in case priorities to support our members/internal medical departments as needed
Complete mandatory Company compliance training and training in new systems and software.
Enter each day’s hours worked in Workday, on the same day.
Perform other duties as assigned
Responsibilities may be adjusted based on changing needs of the organization.

Weekday Requirements:

The Medical reviewer requires 25 hours a week of coverage. The configuration of the 25 hours may change with the business needs, with a minimum of 3 days a week, 2 days at 8 hours and one day at 9 hours. Maximum of 5 days a week of coverage
The Medical Reviewer will take 8 hours off during the week after being primary coverage for a weekend, usually the following Friday.
Each Medical Reviewer will cover one legal holiday /year and will be compensated Holiday pay and straight hours worked
The Medical Reviewer is eligible for Paid Time Off (PTO) and is required to plan and schedule time off with their direct supervisor following the Company policy.

Weekend Requirements:

Each Medical Reviewer is required to be primary coverage one weekend a month
Each Medical Reviewer is required to be available as back up, if needed, one weekend a month
Dental Reviewers have a fixed schedule

Minimum Qualifications:

Licensed M.D. or D.O. or D.M.D. or D.D.S.

Board Certified in a specialty recognized by the American Board of Medical Specialties

Preferred Qualifications:

Board Certified in Internal Medicine , Family Practice, Emergency Medicine
Previous, relevant experience in utilization management and clinical practice
Knowledge of Medicare, Medicaid, and MLTC plans
Time management, critical thinking, communication, and problem-solving skills
Knowledge of UM/QM case philosophies and reporting requirements to state and federal agencies
Knowledge of member satisfaction/incident management and regulations
Knowledge of quality improvement methodologies

Compliance & Regulatory Responsibilities: Ensures compliance to internal Healthfirst and external regulations.

Licensed M.D. or D.O. or D.M.D. or D.D.S.
Annual Compliance and other training as assigned, may include but not limited to hardware, software, and system training upgrades
Annual Inter-Rater Reliability (IRR) Testing
Complies with the Healthfirst Conflict of Interest Policy for Professionals

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $122,907 - $188,020

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.

Apply Now

Refine Your Search

Healthfirst jobs

Medical Peer Reviewer

Support Coordinator

Psychiatric Mental Health Nurse Practitioner - with Substance Use Disorder Treatment

Nurse - Primary Care - Monday - Friday. 4 days on-site, 1 day remote

Family or Internal Medicine Physician

Peer Support Specialist

Chiropractor

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

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

Manager, Medicaid Strategic Initiatives

Bilingual Patient Services Specialist

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

Medical Call Center Rep

Dental Assistant Paid Training Opportunity

Actuarial Analyst

Dental Patient Service Rep (part-time)

Utilization Management Manager

APRN or Physician Assistant

Team Lead Enrollment and Billing

Ancillary Network Account Manager

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