- Healthfirst (NY)
- …technical breadth and depth along with knowledge and understanding of Healthfirst 's and competitive technologies, plans, solutions, and platforms. **Communication & ... Teamwork** + Effectively communicates relevant information to all levels of the organization + Actively participates in organizational change management to ensure successful adoption of new processes and systems + Partner with cross-functional business and IT… more
- Healthfirst (NY)
- …of a clinician (Care Manager/ Case Manager/ Clinical Specialist) + Assists the clinicians by walking the virtual floor and assisting Managers in resolving inquiries. ... + Assists the Manager in monitoring logs of open/closed cases to ensure all are handled appropriately and in a timely manner. + Takes responsibility for complex cases. + Collaborates with the team to provide input on training to new clinicians. + Handles a… more
- Healthfirst (NY)
- …of Medicaid Inspector General, and others. + In collaboration with the Healthfirst Compliance department, oversees the implementation and effectuation of all plans ... that deadlines are met. + Responsible for bringing pertinent items to the Healthfirst Core Workgroup and seeing projects through to fruition to ensure all associated… more
- Healthfirst (NY)
- …+ Produce and manage annual hospital performance review packets. + Monitor costs and revenue trends for hospitals and identify route cause of developing trends. + ... Understand and analyze impacts of new program changes such as new benefits or new populations. + Prepare monthly analysis for analytic council meetings. + Respond to requests for analysis and provide analytic support to network management department and our… more
- Healthfirst (NJ)
- …Review prior authorization requests and units for medications requested under the medical benefit Assess provider-submitted clinical information for clinical ... appropriateness based on predetermined clinical criteria Telephonic/ fax/ mail notification to members and providers of authorization decisions Ensure prior authorization reviews are conducted in time-frames set forth by CMS and/or NYSDOH Establish great… more
- Healthfirst (NY)
- …on Medicare and Medicaid; understand the diverse communities within the Healthfirst service area. Experience working in a matrixed environment where diplomacy ... and collaboration are key to success. more
- Healthfirst (NY)
- …with regulatory agencies and other external organizations + Ensures that Healthfirst meets requirements for all lines of business by developing requirements, ... and maintains departmental work plans and policies & procedures to ensure Healthfirst meets all regulatory requirements + Supervises the performance of direct… more
- Healthfirst (Enfield, NY)
- …audits + When summoned by the Special Investigation Unit (SIU) of Healthfirst , you will be adequately prepared, forthcoming with information and cooperative in ... be able to adapt to various software used by Healthfirst , maintain an electronic book of business, research participating...+ Must keep an open line of communication with Healthfirst Site Development business unit. This will consist of… more
- Healthfirst (NY)
- …Conducts telephonic and virtual home assessments for prospective members and re-assessments of current members using the Uniform Assessment System (UAS) or other ... relevant department approved assessment tool; makes enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills. As needed, conducts telephonic/virtual assessments in settings other than home, eg skilled… more
- Healthfirst (NY)
- …to ensure that departmental productivity goals are met in regards to quality, timeliness, accuracy, and consistency Allocates, monitors, and assigns resources while ... delegating and monitoring workloads Implements and supports continuous process improvement and quality initiatives Provides in-field support to the FCC staff, including supervision, coaching and training Exercises judgment within defined procedures and… more