Top 51 Health first Jobs in New York, Ny

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
Instructional Designer | Hybrid NY or FL
Healthfirst —New York, NY
- $83,100 - $120,360 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- Analysis skills
- Health insurance
- Dental insurance
6d
Peer Support Specialist
Healthfirst —New York, NY
- $34,900 - $54,080 a year
- Overtime
- Spanish
- Microsoft Excel
- Microsoft Outlook
- 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
Senior Manager Clinical Eligibility
Healthfirst —New York, NY
- $105,100 - $188,020 a year
- Full-time
- Spanish
- Nursing
- Microsoft Excel
- 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
6d
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
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
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
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
Learning Delivery Specialist | Hybrid NY or FL
Healthfirst —New York, NY
- $68,900 - $99,620 a year
- Full-time
- Hybrid work
- Classroom
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Sr. Product Specialist
Healthfirst —New York, NY
- $83,100 - $120,360 a year
- Full-time
- Mid-level
- Master's degree
- High school diploma or GED
- Health insurance
- Dental insurance
Senior Network Account Manager
Healthfirst —New York, NY
- $105,100 - $188,020 a year
- Full-time
- Writing skills
- Bachelor's degree
- Mentoring
- Health insurance
- Dental insurance
Configuration and Quality Audit Analyst | Hybrid NY
Healthfirst —New York, NY
- $68,900 - $99,620 a year
- Full-time
- Microsoft Outlook
- Mid-level
- Office
- Health insurance
- Dental insurance
1d
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
Configuration and Quality Audit Manager | Hybrid NY
Healthfirst —New York, NY
- $88,700 - $149,430 a year
- Full-time
- Hybrid work
- 6 years
- Office
- SQL
- Health insurance
- Dental insurance
1d
Product Owner - Enrollment and Billing Correspondence
Healthfirst —New York, NY
- $99,700 - $168,810 a year
- Full-time
- Mid-level
- Office
- High school diploma or GED
- Health insurance
- Dental insurance
Product Strategy Associate
Healthfirst —New York, NY
- $51,000 - $80,070 a year
- Full-time
- Microsoft Outlook
- Writing skills
- Mid-level
- Health insurance
- Dental insurance
1d
Actuarial Analyst
Healthfirst —New York, NY
- $68,900 - $99,620 a year
- Full-time
- Mid-level
- Office
- Finance
- Health insurance
- Dental insurance
14d
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

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health first jobs near new york, ny

Utilization Management Manager

Healthfirst -
New York, NY

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Job Details

Full-time
$99,700 - $168,810 a year

Benefits

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

Qualifications

Associate's degree

Full Job Description

The Manager of Utilization Management provides daily oversight for Case Management teams (which includes RN’s, Social Workers, and Coordinators). The Manager of Utilization Management is responsible for ensuring high quality, cost-effective, and appropriate allocation of member services, treatments, and resources. The Manager of Utilization Management serves as a resource to Healthfirst’s care management team, members, and outside medical providers.

Duties/Responsibilities:

Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, referrals, and other plan services
Develops and monitors goals for staff; provides ongoing feedback and coaching; conducts annual performance reviews; leads by example; and ensures an atmosphere of open communication, teamwork, and ownership and empowerment to make informed decisions
Collaborates with medical staff and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems
Allocate, monitor, and control resources while delegating and monitoring workloads
Develops and analyzes operational and analytical reports to monitor and track operational efficiency
Properly documents utilization management activities and rationale for all decisions in electronic medical records systems
Functions as a clinical resource for the multi-disciplinary care team on an ongoing basis in order to maximize the quality of patient care while achieving effective medical cost management
Additional duties as assigned

Minimum Qualifications:

Associate’s degree
RN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical license
Work experience demonstrating verbal and written communication skills
Experience working independently in a fast-paced environment that requires problem solving skills and handling multiple priorities simultaneously
Experience with Microsoft Office Suite applications including Excel, Word, Power Point and Outlook

Preferred Qualifications:

RN, LPN, LMSW, LMHC, LCSW, or any other relevant clinical license
Master’s degree in a related discipline
Demonstrated professionalism and leadership skills along with the ability to train, develop, direct, and support staff
Experience in managed care, case management, identifying alternative care options, and discharge planning across a variety of treatment settings for high risk, complex populations
Certified Case Manager
Interqual, Milliman, and/or TruCare knowledge
Knowledge of Centers for Medicare & Medicaid Services (CMS), New York State Department of Health (NYSDOH), or MLTCP regulations governing medical management in managed care
Work experience in managed care or healthcare industry in utilization management including preauthorization of outpatient or inpatient services
Knowledge of utilization management/quality management case philosophies and reporting requirements to NY state and federal agencies.

Compliance & Regulatory Responsibilities: The Manager is responsible for ensuring regulatory compliance with CMS, DOH, internal, and other relevant rules.

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $116,800 - $168,810
All Other Locations (within approved locations): $99,700 - $148,325

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.

99700-148325

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Refine Your Search

health first jobs in new york, ny

Utilization Management Manager

Instructional Designer | Hybrid NY or FL

Peer Support Specialist

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

Senior Manager Clinical Eligibility

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

Director, Workforce Analytics and Strategy - Hybrid NY

Director Configuration, Benefit Administration

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

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

Learning Delivery Specialist | Hybrid NY or FL

Sr. Product Specialist

Senior Network Account Manager

Configuration and Quality Audit Analyst | Hybrid NY

Ancillary Network Account Manager

Configuration and Quality Audit Manager | Hybrid NY

Product Owner - Enrollment and Billing Correspondence

Product Strategy Associate

Actuarial Analyst

Senior Manager, Benefits | Hybrid NY

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