Health First jobs in New York, NY - 25 jobs

The Claims Coding Analyst's primary responsibilities require independent judgement in making coding-based decisions on claims and appeals to maintain and enhance Healthfirst's claims editing systems in ensuring proper claims payments, reviewing, researching, and responding to written and emailed correspondence from providers regarding claim denials, and acting as a subject matter expert handling more complex provider issues. They are involved in setting Healthfirst claims policy and ensure that Healthfirst payment policy is aligned with CMS (Centers for Medicare and Medicaid Services), New York State Department of Health (NYSDOH), and all CPT, HCPCS, and ICD-10 coding guidelines, among others. Work Schedule This position requires three days per week in office (Tues/Wed/Thurs) at either: 1101 Greenwood Blvd. Lake Mary, FL. or 100 Church St. New York, NY. Duties & Responsibilities: Conducts independent assessments of current claims edits to ensure comprehensive and defensible claims editing is in place across all Healthfirst product lines. Proactively identifies areas of opportunity with respect to new edits, modifications to existing edits, and recommended claims policy changes. Leads implementation efforts with respect to new or modified edits and works with other departments to ensure proper integration with existing systems and edits. Monitors and reports on performance of current claims editing packages to substantiate savings to Healthfirst. Serves as a subject matter expert to defend claims payment policy disputes and appeals. Reviews claims editing escalated provider disputes/appeals and provides guidance on coding rules and industry standards across all areas of the company with regards to claims editing and proper coding, billing, and payment. Researches and provides feedback on claims editing performance issues, both internally and externally with providers, vendors, etc. Collaborates with claims editing vendors to maintain and update edits as changes in the regulatory, legislative, or industry accepted payment policy requires. Collaborates with other departments to improve compliance with coding conventions and clinical practice guidelines. Leads continuous improvement and quality initiatives to improve processes across departments. Reviews and responds to written provider disputes, clearly and articulately outlining the payment discrepancy to the provider. Thoroughly researches post payment claims and takes appropriate action to resolve identified issues within turnaround time requirements and quality standards. Navigates CMS and State specific websites, as well as AMA guidelines, and compares to current payment policy configuration to resolve the provider payment discrepancies. Reviews medical records to ensure coding is consistent with the services billed and compares against the clinical coding guidelines to determine if a claim adjustment is necessary. Processes claim adjustment requests following all established adjustment and claim processing guidelines. Identifies and escalates root cause issues to supervisor for escalated review. Reviews and responds independently to internally escalated provider disputes transferred by management and other associates. Additional duties as assigned Minimum Qualifications: Coding certification from either American Academy of Professional Coders (AAPC), Certified Professional Coders (CPC) or American Health Information Management Association (AHIMA). High school diploma or GED from an accredited institution. Preferred Qualifications: Previous relevant experience Bachelor's degree in related field Time management, critical/creative thinking, communication, and problem-solving skills Demonstrated professional writing, electronic documentation, and assessment skills. Intermediate Outlook, Basic Word, Excel, PowerPoint, Adobe Acrobat skills. Knowledge of anatomy and pathophysiology medical terminologies. Compliance & Regulatory Responsibilities: See Above License/Certification: See Above WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $68,900 - $99,620 All Other Locations (within approved locations): $61,300 - $91,120 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.

As a valuable member of the Healthfirst Care Management team, the Field Care Coordinator (FCC) is responsible for conducting local home visits for Healthfirst members. During these care management visits, the FCC may perform a home environment assessment, administer health questionnaires, retrieve necessary documentation, and/or facilitate a video visit with a Healthfirst Care Manager or Clinical Eligibility Nurse to conduct other required assessments. When needed, the FCC also supports Healthfirst clinical teams by providing translation services. Duties/Responsibilities: * Schedules and conducts multiple home visits per day (clustered in small geographic areas) * Supports the Healthfirst clinical team members, including UAS nurses and Care Managers, by facilitating cross-cultural communications and interpreting the employee-to-member and member-to-employee conversation * Responds to and, when needed, escalates member questions, as directed * Properly documents findings in Healthfirst information systems * Collaborates with other members of the clinical team (Care Managers, Care Coordinators, Clinical Eligibility Nurses, Medical Directors, etc.) to ensure member needs are prioritized and addressed * Collects documents from members, including health care proxy agreements and other important member documents, and ensures they are routed to the appropriate recipient * Additional duties as assigned Minimum Qualifications: * High school diploma or GED * Bilingual in English and one or more language(s) * Experience using health information systems to document or retrieve information * Proficient computer skills experience, including a solid understanding of Microsoft Outlook, Word and Excel * Ability to travel around downstate New York which includes the 5 boroughs, Long Island, Orange County, and Westchester Preferred Qualifications: * English proficient bilingual who also speaks Spanish, highly preferred * In alignment with our hyper local mission, it is highly preferred that the incumbent resides within a commutable distance to their assigned field location * Ability to commute by car/vehicle * Prior experience in a field-based health care role (home visits a plus) * Work experience as an Interpreter/Translator or in a bilingual customer service role in the field and/or in a call-center * Experience with geriatric or other frail populations, including their caregivers, or in a health care office * Familiar with areas of NYC, Long Island, and/or lower Westchester * A valid NYS driver's license or ID WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: * Greater New York City Area (NY, NJ, CT residents): $48,600 - $65,960 * All Other Locations (within approved locations): $42,200 - $62,400 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.

The Manager, Claims Modernization Reporting and Analytics is responsible for the successful implementation of strategic initiatives as a part of a large team of Business, Data and Project Analysts. This individual will be responsible for partnering with their team in support of process improvement initiatives, development of a reporting and analytics program, as well as in-area and corporate projects. This position will have responsibility for collaborating with executives and stakeholders on defining and developing consumable reporting for use in driving insightful business decisions. This individual will take initiative in improving our overall data quality, testing methodology, creating reporting and visualization that meets the needs of our stakeholders. This position will manage competing objectives and prioritizes accordingly. The Manager will take lead on projects aimed at improving performance and efficiency by leveraging their skills to accomplish tasks and achieve departmental and corporate strategic goals. Job Description * This is a hybrid role and you are expected to report o a HF work location on a regular basis. When you are working remotely, you are expected to have: a secure workplace that is compliant with HIPAA as well as corporate privacy rules; broadband internet service from a reputable provider that supports the applications and functions of your role; be available and reachable by your management team and colleagues at all times during your regularly scheduled hours and adhere to all corporate policies and guidelines. * Your on-site hybrid location is the NY Office at 100 Church Street on Tuesdays, Wednesdays and Thursdays. * Deliver data-driven analytics solutions and visualizations provide meaningful, accurate, and consumable information to department leaders. * Define and implement metrics, quality benchmarks and related analysis on performance and service levels to inform strategic and tactical business decision-making. * Analyze and interpret complex data sets to determine root cause(s) to business performance issues * Recommend business controls to improve business results * Partner with supervisor and peers to establish goals, priorities and deliverables of Business/ Project Analyst team. Ensure long-term strategic and short-term tactical Operational needs for process improvement, reporting, and project support are agreed upon and accomplished. * Manage progress and deliverables on all initiatives, consistently seeking more efficient ways to support the business using technology, cross-training, and other tools to ensure their own optimal performance as well as performance of the Business/Project Analyst team. * Regularly meet with supervisor, peers, and stakeholders to drive high performance results. * Collaborate across impacted stakeholders to translate business needs into technology solutions, implement reporting tools that maximize efficiency, and foster a high-performance culture. * Gather business requirements, develop business rules, and implement process controls and reporting. * Prioritize, and monitor workload to ensure continuous progress in being made. * Remain current on reporting and database technologies and ensure Healthfirst is leveraging existing systems to maximize optimal value. * Collaborate with Information Technology, Business Transformation and Operations teams to support effective department management including introducing new technology, system upgrades and reporting impacts and providing leadership dashboards to assist with managing our business. * Articulate conclusions and opinions in a persuasive and influential manner, with well-developed data-driven analyses or solutions that establish trust. * Partner on development and implementation of a strategic multiyear project and resources plan and participate in setting and executing operational plans consistent with organizational strategy. * Support a variety of ad-hoc report requests. * Attend and conduct team/project meetings as needed * Additional projects and duties as assigned. Minimum Qualifications: * Experience exhibiting strong critical thinking, problem solving, and analytical skills. * Experience within any area of operations (Member Services, Enrollment & Billing, Claims, Provider Services, etc.). * Experience with database reporting and automation, budgeting or internal audit processes. * Experience monitoring quality in a reporting and analysis environment. * Experience conducting root-cause analysis and making recommendations based on your findings. * Experience with Tableau, Alteryx, or similar data visualization and data wrangling tools. * Familiarity with relational database structures, theories, principles, and practices. * Familiarity with data models and/or data modelling. * Experience with Microsoft Excel including the use of formulas, Pivot tables, and graphs to manipulate and analyze data. * Bachelor's degree from an accredited institution or equivalent work experience. Preferred Qualifications: * Experience working within a Healthcare industry (such as commercial insurance plans, hospital, managed long-term care or government programs). * Familiarity with healthcare data. * Experience working with MS Office Suite, including MS Access (reporting), MS PowerPoint (creating/editing presentations), and MS Visio (creating flow charts) and Adobe Acrobat (converting PDF files). * Ability to gather requirements, design, test and implement using agile methodologies. * Advanced communication skills with the ability to present to a varied audience, including Senior Management. * Problem solving skills; ability to think strategically and critically in developing solutions to complex problems. * Strong quantitative and analytical skills. Compliance & Regulatory Responsibilities: N/A License/Certification: N/A WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: * Greater New York City Area (NY, NJ, CT residents): $103,400 - $149,430 * All Other Locations (within approved locations): $88,700 - $131,920 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.

The Technology Associate is a role intended to create meaningful experiences for recent college graduates who have a passion for a future in technology through the Healthfirst Technology Early Career Development Program. This is a full-time role that provides an immersive and rigorous technology experience, that lays a meaningful foundation for continued growth, development, and leadership within IT. Technology Associates do impactful work collaborating with Healthfirst employees and leaders at all levels including solving business problems and delivering technology solutions by working on one of 13 technical or business delivery teams. The incumbent completes a comprehensive curriculum built into the program which includes on the job, virtual and in-classroom training focusing on technical and professional skill advancement. Associates are coached and mentored by industry leaders, who serve as IT Program Champions for the duration of the program. This position requires three days per week in office (Tues/Wed/Thurs) at 100 Church Street, NYC For this role we are looking for candidates with project, internship or work experience with object-oriented programming languages such as Java, C+ and C. Candidates should have fundamental skills in front end, backend and full stack development. Candidates for this role should be interested in growing their skills in various technologies that will allow them to grow into full stack developers within one of our many technology teams at Healthfirst. We are seeking undergraduates who will have graduated within 12 months of the program start on 09/2026. Candidates must be on track to graduate in May 2026 or have graduated in December of 2025. Duties & Responsibilities: * Design and build solutions for complex technical issues and problems * Participate in developing specifications, such as user stories and designs * Write and maintain documentation to describe the program design, development, logic, coding, testing, and changes. * Foster a team and agile approach to software development and delivery * Develop unit tests and provide code coverage to accurately test business logic and functionality * Stay current in new IT technologies * Perform deployments, manage continuous integration and continuous delivery * Advance technical and professional skills by completing the learnings in the Technology Early Career Development Program curriculum * Data mapping and cleansing of raw data, learning upstream and downstream dependency flows and understanding the IT applications and Business needs * Other related duties as assigned by their specific teams Minimum Qualifications: * Professional or academic experience in solving technical problems * Experience demonstrating written, verbal and presentation communication skills with ability to communicate complex information * Experience demonstrating prioritization and the ability to multi-task while maintaining attention to detail * Experience working independently and as part of a team * Computer Science or technology related bachelor's degree from an accredited institution * Received undergraduate degree within past 6 months or currently enrolled in graduate program * Eligible to work in the US without requiring sponsorship now or in the future * NY Hybrid role - must be able to commute to the office as needed Preferred Qualifications * Knowledge of project management concepts * Familiarity with Agile methodology * Proficiency in software development using at least 1 programming language * Proficiency in data structures * Excellent influencing and negotiation skills Compliance & Regulatory Responsibilities: N/A License/Certification: N/A WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: * Greater New York City Area (NY, NJ, CT residents): $66,500 - $90,440 * All Other Locations (within approved locations): $57,500 - $85,510 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.

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member. We are a community of individuals from diverse people who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit *************************** for more information about the Amida Care culture. We are actively seeking a highly motivated, innovative and experienced individual to join our team as the Care Coordinator - TGNB Health. Compensation will be commensurate with experience. Position Summary: This position requires experience in Transgender/Non-Binary (TGNB) clinical care and gender affirming surgery (GAS) and plays a key role in the coordination of Amida Care's TGNB clinical services, and care coordination for TGNB members, as well as serves as a resource for the community, Amida Care staff, community partners, and providers. Responsibilities Clinical leader for TGNB Care Coordination and TGNB Health. Participate in regularly scheduled ICT Meetings. Ensure Amida Care's Integrated Care Model is operationalized with team structure and the members' complex multidisciplinary service needs are met. Perform clinical oversight of case review, employing critical thinking skills and presenting cases to medical directors and other clinicians. Communicate with members to ensure they are receiving services and case in accordance with established clinical guidelines and the Plan's benefit package; review clinical documentation, including laboratory values, to ensure members are receiving appropriate care and implement strategies to address unmet needs as appropriate. Ensure completion of documented care coordination with the Amida Care Authorizes operation systems. Perform daily review of inpatient census to ensure members are receiving care and services in accordance with established clinical guidelines in the most appropriate care setting. Follow up with members and providers when a need is identified that will support improved health outcomes for behavioral and physical health. Provide direct services to members, including psychosocial reassessments, risk reduction activities, community outreach, and events targeting individuals of transgender experience living with HIV/AIDS as needed. Provide direct individual interventions including elements of case management and advocacy, referral and follow-up meetings in-person or by telephone. Engage members and providers when a need is identified that will support improved health outcomes for the behavioral and physical health of members of transgender experience. Provide education on gender affirming procedures, hormone treatment and risk reduction strategies. Participate in review of clinical documentation, claims/utilization data to ensure members are receiving appropriate care and implement strategies to address unmet needs as appropriate. Conduct needs assessments to determine appropriate referrals and support. As needed, conduct focus groups with members of transgender experience to increase quality of care and services delivered at Amida Care. Provide support to the member services call center as it is related to GIST needs. Attend continuing education seminars, staff in-services and stay current with relevant literature to maintain familiarity with trends in transgender services. Ensure member confidentiality and adheres to Confidentiality and Health Insurance Portability and Accountability Act (HIPPA) policies and regulations. Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do. EDUCATION REQUIRED Minimum Licensed Practical Nurse license required. EXPERIENCES AND/OR SKILLS REQUIRED One (1) year experience working with the transgender community, preferred. Knowledge of transgender surgical procedures, preferred. One (1) year experience with HIV/AIDS, medical, or chronic care preferred. Ability to communicate in Spanish for basic medical interactions, preferred. Strong knowledge of Microsoft Office (Access, Word and Excel). Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts. Demonstrate appropriate behaviors in accordance with the organization's vision, mission, and values.

Under the direction of the Manager of Ancillary Services, the Ancillary Services Network Account Manager I develops and maintains an Ancillary provider network that ensures Healthfirst members have superior access to the highest quality by focusing efforts on lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction. The individual must possess experience working in a managed care setting with specific background in network development, provider recruitment, provider outreach, claim resolution, provider education and contract negotiations. Works with multiple provider types, e.g. physician, ancillary, medical groups, behavioral health or hospitals to supports a full range of contract arrangements and pricing mechanisms. * Manage a network of Ancillary Providers for all lines of Healthfirst's business (such as Medicaid, CHP, Medicare, and Commercial). * Monitor and audit contracted ancillary providers to ensure that accurate demographic, payment and fee schedules are loaded into the HF Provider System correctly. * Resolve configuration issues by identifying root causes in order to prevent claims denials and to ensure claims are paid correctly. * Facilitate meetings cross-departmentally to achieve positive outcomes in management of ancillary provider network. * Create contracts in HF contract software and review credentialing documents submitted by Provider/facility via Universal Credentialing Data Source, The Council for Affordable Quality Healthcare (CAQH) or PDF application to ensure that all the required credentials are included and that valid documents for behavioral Providers and facilities are provided * Negotiate and execute Single Patient Agreements for Out Of Network (OON) Providers in order to determine the Provider's payment arrangement. * Individual should be familiar with contracting and reimbursement methodologies for ancillary services providers. * Educate newly credentialed Providers on Healthfirst's policies and procedures such as billing and authorization requirements, utilization of Healthfirst's Provider portal, claims submission, etc., via various methods (telephonic, face-to-face, webinar, etc.). * Analyze provider network based on monthly report to ensure that Plan is meeting Health Plan Network (HPN) State requirements. * The individual would work closely with Network Management, Credentialing, and the business analytics unit within the Ancillary department, to complete the analysis. * Identify root cause of claims issues and facilitate resolution by working closely with Reimbursement and Claims departments. Clearly communicate resolutions and progress to the Providers. * Assist Appeals and Grievances (A&G) department by acting as liaison between Providers and A&G department to achieve favorable outcomes of member related issues, complaints, balance billing and other issues. * Ensure that all Providers' inquiries received via email and phone call are addressed efficiently and effectively within required time-frame. * Assist management with research and facilitation of projects related to contract updates, new product implementation and new reimbursement methodologies. * Additional duties as assigned Minimum Requirements: * Experience managing or performing high level servicing to a portfolio of customers/providers * Contracting experience - Ability to work independently in dynamic environment * Ability to take initiative and work independently * Ability to prioritize and multi-task * Strong customer-centric and analytical skills * Strong sense of urgency and self-motivational qualities * Excellent oral and written communication skills * High School Diploma or GED WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: * Greater New York City Area (NY, NJ, CT residents): $68,900 - $99,620 * All Other Locations (within approved locations): $61,300 - $91,120 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.

The Technology Associate is a role intended to create meaningful experiences for recent college graduates who have a passion for a future in technology through the Healthfirst Technology Early Career Development Program. This is a full-time role that provides an immersive and rigorous technology experience, that lays a meaningful foundation for continued growth, development, and leadership within IT. Technology Associates do impactful work collaborating with Healthfirst employees and leaders at all levels including solving business problems and delivering technology solutions by working on one of 13 technical or business delivery teams. The incumbent completes a comprehensive curriculum built into the program which includes on the job, virtual and in-classroom training focusing on technical and professional skill advancement. Associates are coached and mentored by industry leaders, who serve as IT Program Champions for the duration of the program. This position requires three days per week in office (Tues/Wed/Thurs) at either: 100 Church Street, NYC For this role we are looking for candidates with project, internship or work experience with business systems and processes and SDLC (Software Development Life Cycle). Candidates should have fundamental knowledge and skills in Agile methodologies and knowledge of object-oriented programming would be helpful as well. Candidates for this role will have strong communication and people skills and should be interested in growing their skills in various technologies that will allow them to grow into Product Owners and or Business Analysts within one of our many technology teams at Healthfirst. We are seeking undergraduates who will have graduated within 12 months of the program starting on 09/2026. Candidates must be on track to graduate in May 2026 or have graduated in December of 2025. Duties & Responsibilities: * Design and build solutions for complex technical issues and problems * Participate in developing specifications, such as user stories and designs * Write and maintain documentation to describe the program design, development, logic, coding, testing, and changes. * Foster a team and agile approach to software development and delivery * Develop unit tests and provide code coverage to accurately test business logic and functionality * Stay current in new IT technologies * Perform deployments, manage continuous integration and continuous delivery * Advance technical and professional skills by completing the learnings in the Technology Early Career Development Program curriculum * Data mapping and cleansing of raw data, learning upstream and downstream dependency flows and understanding the IT applications and Business needs * Other related duties as assigned by their specific teams Minimum Qualifications: * Professional or academic experience in solving technical problems * Experience demonstrating written, verbal and presentation communication skills with ability to communicate complex information * Experience demonstrating prioritization and the ability to multi-task while maintaining attention to detail * Experience working independently and as part of a team * Computer Science or technology related bachelor's degree from an accredited institution * Received undergraduate degree within past 6 months or currently enrolled in graduate program * Eligible to work in the US without requiring sponsorship now or in the future * NY Hybrid role - must be able to commute to the office as needed Preferred Qualifications * Knowledge of project management concepts * Familiarity with Agile methodology * Proficiency in software development using at least 1 programming language * Proficiency in data structures * Excellent influencing and negotiation skills Compliance & Regulatory Responsibilities: N/A License/Certification: N/A WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: * Greater New York City Area (NY, NJ, CT residents): $66,500 - $90,440 * All Other Locations (within approved locations): $57,500 - $85,510 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.

The Technology Associate is a role intended to create meaningful experiences for recent college graduates who have a passion for a future in technology through the Healthfirst Technology Early Career Development Program. This is a full-time role that provides an immersive and rigorous technology experience, that lays a meaningful foundation for continued growth, development, and leadership within IT. Technology Associates do impactful work collaborating with Healthfirst employees and leaders at all levels including solving business problems and delivering technology solutions by working on one of 13 technical or business delivery teams. The incumbent completes a comprehensive curriculum built into the program which includes on the job, virtual and in-classroom training focusing on technical and professional skill advancement. Associates are coached and mentored by industry leaders, who serve as IT Program Champions for the duration of the program. This position requires three days per week in office (Tues/Wed/Thurs) at 100 Church Street, NYC For this role we are looking for candidates with project, internship or work experience SQL, Java, C. Candidates should have fundamental knowledge or skills in unit testing and databases. Candidates for this role should be interested in developing their skills in various technologies that will allow them to grow into Quality Assurance testers within one of our many technology teams at Healthfirst. We are seeking undergraduates who will have graduated within 12 months of the program starting on 09/2026. Candidates must be on track to graduate in May 2026 or have graduated in December of 2025. Duties & Responsibilities: * Design and build solutions for complex technical issues and problems * Participate in developing specifications, such as user stories and designs * Write and maintain documentation to describe the program design, development, logic, coding, testing, and changes. * Foster a team and agile approach to software development and delivery * Develop unit tests and provide code coverage to accurately test business logic and functionality * Stay current in new IT technologies * Perform deployments, manage continuous integration and continuous delivery * Advance technical and professional skills by completing the learnings in the Technology Early Career Development Program curriculum * Data mapping and cleansing of raw data, learning upstream and downstream dependency flows and understanding the IT applications and Business needs * Other related duties as assigned by their specific teams Minimum Qualifications: * Professional or academic experience in solving technical problems * Experience demonstrating written, verbal and presentation communication skills with ability to communicate complex information * Experience demonstrating prioritization and the ability to multi-task while maintaining attention to detail * Experience working independently and as part of a team * Computer Science or technology related bachelor's degree from an accredited institution * Received undergraduate degree within past 6 months or currently enrolled in graduate program * Eligible to work in the US without requiring sponsorship now or in the future * NY Hybrid role - must be able to commute to the office as needed Preferred Qualifications * Knowledge of project management concepts * Familiarity with Agile methodology * Proficiency in software development using at least 1 programming language * Proficiency in data structures * Excellent influencing and negotiation skills Compliance & Regulatory Responsibilities: N/A License/Certification: N/A WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: * Greater New York City Area (NY, NJ, CT residents): $66,500 - $90,440 * All Other Locations (within approved locations): $57,500 - $85,510 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.

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member. We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit ************************** for more information about the Amida Care culture. We are actively seeking a highly motivated, innovative and experienced individual to join our team as the Vice President of Operations. Compensation will be commensurate with experience. Position Summary: In collaboration with and under the direction of the Chief Operating Officer, the Vice President of Operations is responsible for managing all hands-on operational aspects of the plan and will assist the COO in successfully meeting the goals of the organization. This executive role is responsible for the overall direction and administration of key operational departments, programs and services provided by the health plan. Responsibilities: The Vice President of Operations will provide leadership and administrative report to the Claims/Encounter, Reporting, Provider Services, Credentialing and Vendor Management Teams. Responsible for ensuring a comprehensive cost efficient and accessible provider network that is contracted and linked to appropriate fee schedules. Manages the end-to-end contracting process, including credentialing, outreach, recruitment, contract initiation, and provider services for all risk arrangements including Valure Based providers. Proactively identifies risks and opportunities for improvement by utilizing a data driven mind set to solution and improve operations through automation and workflow redesign. Provide leadership, management, and vision necessary to ensure that the company has the proper operational controls, administrative and reporting procedures, and people systems in place to effectively grow the organization and to ensure financial strength and operating efficiency. Strategic though leader responsible for claims insights and analytics to drive efficiency and financial responsibility, are also critical aspects of the role. Drives the development, negotiation, and execution of vendor contracts, including RFIs, RFPs, Statements of Work (SOWs), and final agreements, ensuring alignment with business, clinical, and financial goals. Build and maintain relationships with key internal and external stakeholders to ensure the successful outcome of business objectives and goals. Accountable for ensuring departmental compliance with contractual, regulatory, and corporate requirements, guidelines, and goals including turnaround times, timely submissions, and reporting. Oversee implementation / project management both contractually and operationally for new vendors and third-party software outside of IT. Ensures efficient processes and proper follow-up with our external vendors. Development of key metrics and KPIS for operational effectiveness. Oversee monitoring of the vendor process of to ensure and monitor process of timely submission and error corrections and resubmissions. Responsible for the hiring and retention of quality staff and the on-going planning, monitoring, training, coaching, evaluation, and appraisal of staff performance and development to ensure successful achievement of goals and objectives. Other duties as assigned. Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do. EDUCATION REQUIRED Bachelor's degree combined with 10+ years of experience in Health Plan Operations and Information Technology. EXPERIENCES AND/OR SKILLS REQUIRED Over 10 years of progressive Managed Care experience spanning claims, provider contracting, and vendor management. Extensive background with New York State Medicaid in a health plan environment, including more than five (5) years in senior-level roles. In-depth working knowledge of Medicaid regulatory reporting requirements (e.g., MMCOR, SNPOR) for the New York State Department of Health and CMS. Strong analytical, innovative, and critical thinking skills. Collaborative and inclusive leadership style. Open to feedback and considering new ideas and approaches. Exceptional interpersonal and verbal/written communication skills. Strong computer skills, including MS Office (EXCEL, Word, Power Point). Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts. Demonstrate appropriate behaviors in accordance with the organization's vision, mission, and values.

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member. We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit ***************************** more information about the Amida Care culture. We are actively seeking a highly motivated, innovative and experienced leader to join our team as the Member Services Representative - Bilingual . This position will be a member of the senior management team. Compensation will be commensurate with experience. Position Summary: The Bilingual Member Services Representative position supports the Member Services Departments goal and mission to deliver the highest level of customer service and support for members and providers in a call center setting. The Member Services Representative is responsible to answer and resolve high volume of Spanish/English member and provider inquires, concerning benefits, services, and claims. This role is also responsible for completing outbound campaigns for member outreach, education, onboarding of members and quality initiative projects. Responsibilities: Answer members and providers' inquiries concerning plan benefits, claims and complaints. Escalate complex and urgent member care needs to the appropriate Management or departments. Transfer members to Amida Care's Partners for Services provided on behalf of Amida Care. Navigate different systems and databases to resolve members' issues or concerns. Document all conversations/touchpoints in the Amida Care system (Salesforce). Meet Quality Assurance requirements and other call center key performance metrics. Collect and document prospective members information the Amida Care system (Salesforce). Conduct outbound calls for projects and member outreach follow-ups. Confirm and update member contact information and demographic, such as address, phone numbers & Primary Care Provider etc, Promote and educate members on plan benefits, services, programs, alerts, and reminders. Conduct New Member Orientation as assigned. Utilize translation line as needed to communicate with members. Attend events as needed: Town Hall Meetings, Live Your Life (LYL) Events, NML (New Member Luncheon). Provide feedback to management teams on any trending member inquiries and/ or activities for process improvement. Perform other duties as assigned. Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do. EDUCATION REQUIRED High School Diploma or equivalent combination of education and relevant work experience required. EXPERIENCES AND/OR SKILLS REQUIRED Bilingual Spanish/ English. Minimum one (1) years' experience in Customer Service. Must be able to maintain strict confidentiality of sensitive member's information (HIPAA) Proficiency in Microsoft Office (Word, Excel). Strong verbal and written communication skills in English and Spanish. Ability to sit for an extended period. Ability to manage multiple tasks and work consistently in a fast-paced environment. Understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts in accordance with the organization's vision, mission, and values.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Healthfirst is New York City's largest not-for-profit health insurer, dedicated to improving health through community-driven, value-based care. For over 30 years, we have led the shift from volume to value by focusing on better outcomes, preventative care, and cost efficiency. Recognized by Forbes as a Dream Employer of 2025, Healthfirst is committed to fostering a culture of innovation, creativity and belonging. As a UAS Nurse Assessor, you will help ensure our members receive the care and services they need to lead healthier, more independent lives. This role is perfect for RNs who are passionate about making a positive impact in the lives of patients/families and appreciates a job with flexibility and manageable caseloads. Whether you're an experienced nurse or a new graduate eager to start your career, you'll have the opportunity to grow in a supportive environment. Enjoy the benefit of working in the field while also conducting in-person assessments throughout Bronx-close to great public transportation, shopping centers, and some of NYC's most vibrant neighborhoods. What we offer: * Flexible work schedule (4x10s or M-F ) * No weekends, holidays or night shifts * Full benefits; Medical, Dental, Vision, Retirement, Employee Wellbeing & Assistance Programs, Paid Time Off (PTO) & more! * Immersive 6-week training program to support you and set you up for success * Professional growth & development opportunities Duties and Responsibilities: * Conducts home assessments (and virtual assessments, as needed) for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills. As needed, conducts assessments in settings other than home as needed, e.g. skilled nursing facilities or virtually * Navigates multiple technology/digital platforms such as UAS software, electronic medical records, TruCare, etc., to conduct and document comprehensive assessments accurately and efficiently * Completes assessment of service needs per CMT and member's family/caregiver's request to determine service needs or any necessary adjustments * Reviews previous nursing assessments/medical notes to determine necessary adjustments/updates in Care Plan and/or to assist with nursing home admission * Conducts in-person Care Management visits in support of person-centered service planning * Liaisons between the member and the CMT; assesses home environment and psychosocial status * Provides feedback to home care agencies and CMT regarding home care issues and contract nurses and aides performance * Provides grass roots, community-based training for frail population care including self-care techniques and prevention strategies * Ensures (prospective) members and significant others/responsible parties understand and are in agreement with enrollment in a managed long-term care plan * Additional duties as assigned Minimum Qualifications: * New York State RN license * Ability to travel around downstate New York which includes the 5 boroughs, Long Island, Rockland, and Westchester. * Prior work experience requiring technological proficiency including the ability to navigate multiple technology platforms and modalities * Prior work experience requiring intermediate Microsoft Word, Excel, and Outlook skills * Prior work experience requiring time management, critical/creative thinking, communication, and problem-solving skills * For PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations Preferred Qualifications: * Work experience using electronic patient health information (PHI) database usage especially UAS * Previous field-based experience assessing, planning, and evaluating member's care by making home or facility visits for intake/reassessments or start of care (SOC) Community Home Health Agency (CHHA) visits * Work experience preferred in one or more of the following areas, geriatrics, home care, discharge planning, case management, and/or medical surgical nursing * Knowledge of health insurance, Medicaid, Medicare and MLTCP * Experience working with a frail adult or elderly population with the ability to determine appropriate care plans and services for frail population as well as negotiate initial service plans so that members and families are in agreement * Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese * Demonstrated ability handling heavy caseloads * NY state driver's license WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: * Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470 * All Other Locations (within approved locations): $71,600 - $106,505 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.

The Technology Associate is a role intended to create meaningful experiences for recent college graduates who have a passion for a future in technology through the Healthfirst Technology Early Career Development Program. This is a full-time role that provides an immersive and rigorous technology experience, that lays a meaningful foundation for continued growth, development, and leadership within IT. Technology Associates do impactful work collaborating with Healthfirst employees and leaders at all levels including solving business problems and delivering technology solutions by working on one of 13 technical or business delivery teams. The incumbent completes a comprehensive curriculum built into the program which includes on the job, virtual and in-classroom training focusing on technical and professional skill advancement. Associates are coached and mentored by industry leaders, who serve as IT Program Champions for the duration of the program. This position requires three days per week in office (Tues/Wed/Thurs) at 100 Church Street, NYC. For this role we are looking for candidates with project, internship or work experience with SQL and Python. Candidates should have fundamental knowledge and skills in data pipelining and cloud technologies (AWS, Azure, GCP). Candidates for this role should be interested in growing their skills in various technologies that will allow them to grow into Data/Cloud Engineers within one of our many technology teams at Healthfirst. We are seeking undergraduates who will have graduated within 12 months of the program starting on 09/2026. Candidates must be on track to graduate in May 2026 or have graduated in December of 2025. Duties & Responsibilities: * Design and build solutions for complex technical issues and problems * Participate in developing specifications, such as user stories and designs * Write and maintain documentation to describe the program design, development, logic, coding, testing, and changes. * Foster a team and agile approach to software development and delivery * Develop unit tests and provide code coverage to accurately test business logic and functionality * Stay current in new IT technologies * Perform deployments, manage continuous integration and continuous delivery * Advance technical and professional skills by completing the learnings in the Technology Early Career Development Program curriculum * Data mapping and cleansing of raw data, learning upstream and downstream dependency flows and understanding the IT applications and Business needs * Other related duties as assigned by their specific teams Minimum Qualifications: * Professional or academic experience in solving technical problems * Experience demonstrating written, verbal and presentation communication skills with ability to communicate complex information * Experience demonstrating prioritization and the ability to multi-task while maintaining attention to detail * Experience working independently and as part of a team * Computer Science or technology related bachelor's degree from an accredited institution * Received undergraduate degree within past 6 months or currently enrolled in graduate program * Eligible to work in the US without requiring sponsorship now or in the future * In office role must be able to commute to the office on Tues, Wed and Thurs every week. * At this time, Healthfirst will only consider applicants who are presently authorized to work for any employer in the United States and who will not require visa sponsorship from Healthfirst, now or in the future, to retain their authorization to work in the United States. Preferred Qualifications * Knowledge of project management concepts * Familiarity with Agile methodology * Proficiency in software development using at least 1 programming language * Proficiency in data structures * Excellent influencing and negotiation skills Compliance & Regulatory Responsibilities: N/A License/Certification: N/A WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: * Greater New York City Area (NY, NJ, CT residents): $66,500 - $90,440 * All Other Locations (within approved locations): $57,500 - $85,510 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.

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement, and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member. We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit ************************** for more information about the Amida Care culture. We are actively seeking a highly motivated, innovative and experienced leader to join our team as the High-Risk Care Manager - Children Focus. Compensation will be commensurate with experience. Position Summary: This position serves as the primary point of contact for pediatric members and their respective head of household. The position is also responsible for intensive care management for a cohort of adult members with a High-Risk designation. The position is an integral part of the member's assigned Integrated Care Team (ICT). Objectives of the position include being responsible for children/adolescent members and pregnant/post-partum members. The Care manager's role is to ensure members' complex medical, behavioral, pharmaceutical and psychosocial needs are met within the established benefit policies and guidelines. The Care Manager must have strong critical thinking skills and have knowledge of and/or experience working with vulnerable populations including transgender adolescents and people living with HIV. Responsibilities: Provide clinical guidance to and share administrative oversight of the Amida Stork program (Pregnant and Neonates Program), including outreach to providers (e.g. obstetricians) and members/heads of household/legal guardians. Provide coordination and accountability in managing the care of pediatric/adolescent members; this cohort includes transgender members under the age of 22 years. Serve as a primary point of coordination/accountability in managing the care of adult High-Risk members, including members with unsuppressed HIV Viral load. Participate in quality initiatives, such as gaps in care (GIC), including outreach to provider and/or members, for recommended screenings, examinations, etc. Facilitate the delivery of services to members, including facilitating referrals to medical, behavioral health and social assistance entities and other services to support wellness and health care compliance. Coordinate access for members to other services such as home health care, Health Home, durable medical equipment (DME), hospice care, pharmaceutical, transportation and family planning. Participate in both internal and external case conferences, which include collaborating as part of multidisciplinary team for high-risk members. Establish effective communication with obstetric, pediatric, and primary care sites, as well as health department and community partners and hold collaborative and interdisciplinary meetings to promote family and child health. Collaborates closely with the Voluntary Foster Care (VFCA) Liaison, who serves as the primary point of contact for members engaged in foster care. Communicate effectively with the health services teams, other departments and external entities. Collaborate with Gender Identity Support Team (GIST) to find and develop culturally sensitive care for members, including trans-informed obstetric care within the Amida Care network for transgender/non-binary (TGNB) members. Assist with transitions of care for members admitted to in-patient facilities. Promptly review and address any crisis situations that arise for any client with supervisory staff, service network and any other required entities. Ensure completion of documented care coordination using the Amida Care authorized platforms. Ensure member confidentiality and adhere to Confidentiality and Health Insurance Portability and Accountability Act (HIPPA) policies and regulations. Perform other duties as assigned. Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote, and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do. EDUCATION REQUIRED NYS Registered Nurse or LPN. EXPERIENCES AND/OR SKILLS REQUIRED Three (3) years' experience in clinical setting and/ or managed care setting, five (5) years preferred. Experience working with people living with HIV/AIDS or serious chronic illness, preferred. Experience working with settings treating behavioral health and substance use conditions, preferred. Experience working with children/adolescents with complex care needs. Strong knowledge of Microsoft Office (Outlook, Word and Excel). Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts. Demonstrate appropriate behaviors in accordance with the organization's vision, mission, and values.

The Integrated Products Project Liaison provides administrative support to the Integrated Products (IP) Sales group's growth initiatives for long-term care products. This includes, but is not limited to, coordinating the continuity of the IP pre-enrollment process and ensuring the processing of quality customer service for referral sources, prospective new enrollees and internal partners. Project Liaison is expected to contribute creative solutions and take ownership of daily assignments to ensure seamless communication and systematic completion of routine and special projects. They are expected to facilitate meetings and conference calls with project participants acting in a consultative capacity. This is a paperless work environment requiring daily hands-on administration of multiple proprietary and packaged electronic databases including security requirement tools such as encryption. These systems include, but are not limited to, Salesforce, Tableau, Macess Service Module, MS Office software (Word, Excel, PowerPoint, Excel, Outlook, etc.), and Adobe Acrobat. The Project Liaison maintains control of the division's workflow as directed by the District Managers, Senior Managers of MLTC/MAP Growth, and Director of Growth and Account Network Operations (MLTC/MAP) while working independently to ambitiously handle multiple tasks with a fast-paced, proactive vs. a reactive approach to changing priorities. The Project Liaison must have the ability to manage projects across multiple units within the organization with the respective Integrated Products Sales Manager or Director as the key stakeholder. Key duties within the role include: * Provides administrative support to Long Term Care Sales department by acting as liaison among LTC Sales, PHSP Sales, Medicare Sales, Intake, Ancillary, Fleet, Community Engagement and Clinical Teams as necessary. * Works collaboratively with Finance/IS/IT in obtaining and summarizing growth, membership and staffing reports * Assists in staff onboarding through ordering of all equipment and scheduling any necessary training * Monitors annual premiums budget, as well as in-house/warehouse inventory of marketing supplies/premiums. * Prepare marketing packages, including the ordering and stocking of product specific marketing materials for the full Integrated Products Sales Team. * Assists with data entry of Marketing/Provider Contacts into a designated database (Salesforce) as needed. * Handle incoming telephone calls from field marketing staff and leadership in a prompt, courteous and appropriate manner. * Pulls and updates provider specific referral reports for Sales Leaders and marketing staff, with validated information, in a timely manner. * Identifies opportunities to streamline reporting for the Sales Leaders * Reviews and summarizes performance dashboards for the IP Sales Team * Schedules and maintains various meeting calendars. * Takes all team meeting specific minutes and follow-up items. * Develops and maintains all provider specific quarterly presentation decks. * Develops field presence heat maps and identifies opportunities for growth through on-site marketing efforts * Tracks and distributes team commission/bonus statements * Acts as the primary point of contact within Integrated Sales, for any Community Engagement Events/Sponsorships * Monitors and requests maintenance for full team equipment such as laptops, phones, VPN devices, etc. * Other duties as assigned. * Must be willing to work overtime if needed. Minimum Qualifications: * High School diploma/GED or equivalent experience * Strong planning, organizing, and execution skills - experience managing a range of concurrent large scope projects * Ability to craft communications, set meetings and organize schedules in Microsoft Outlook * Ability to communicate effectively verbally and in writing * Ability to establish and maintain relationships with key stakeholders * Advanced level Excel capabilities including Data Sorting, Data Filters, Pivot Tables and V Lookups * Be able to work in a fast-paced environment Preferred Qualifications: * Bachelor's degree * 1-3 years of long-term care experience * Change leadership skills coupled with exceptional relationship building and influencing ability * Problem solving skills; ability to think strategically and critically in developing solutions to complex problems * Creativity and flexibility in addressing future challenges in alignment with Healthfirst's long-term growth and profitability goals WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. Know Your Rights All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: * Greater New York City Area (NY, NJ, CT residents): $48,600 - $65,960 * All Other Locations (within approved locations): $42,200 - $62,400 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.

The Assessment Nurse makes field assessment visits for members or prospective members around downstate New York at intervals required by the Department of Health (DOH) and completes appropriate documentation to determine members' enrollment, service needs, and continued plan eligibility. This position coordinates with Care Management Team (CMT) to maintain efficient and effective operations of Healthfirst's long term care plans such as CompleteCare and Senior Health Partners. Duties and Responsibilities: Conducts home assessments (and virtual assessments, as needed) for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills. As needed, conducts assessments in settings other than home as needed, e.g. skilled nursing facilities or virtually Completes assessment of service needs per CMT and member's family/caregiver's request to determine service needs or any necessary adjustments Reviews previous nursing assessments/medical notes to determine necessary adjustments/updates in Care Plan and/or to assist with nursing home admission Conducts in-person Care Management visits in support of person-centered service planning Liaisons between the member and the CMT; assesses home environment and psychosocial status Provides feedback to home care agencies and CMT regarding home care issues and contract nurses and aides performance Provides grass roots, community-based training for frail population care including self-care techniques and prevention strategies Ensures (prospective) members and significant others/responsible parties understand and are in agreement with enrollment in a managed long-term care plan Additional duties as assigned Minimum Qualifications: New York State RN license Valid New York State ID Ability to travel around downstate New York which includes the 5 boroughs, Long Island, Rockland, and Westchester. For PEDS positions only: 1 year of pediatric clinical field experience and/or experience with families and child serving systems, including child welfare and/or medically fragile/developmentally disabled populations Preferred Qualifications: Previous field-based experience assessing, planning, and evaluating member's care by making home or facility visits for intake/reassessments or start of care (SOC) Community Home Health Agency (CHHA) visits Work experience preferred in one or more of the following areas, geriatrics, home care, discharge planning, case management, and/or medical surgical nursing Work experience using electronic patient health information (PHI) database usage especially UAS NY state driver's license Knowledge of health insurance, Medicaid, Medicare and MLTCP Experience working with a frail adult or elderly population with the ability to determine appropriate care plans and services for frail population as well as negotiate initial service plans so that members and families are in agreement Time management, critical/creative thinking, communication, and problem-solving skills Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese Demonstrated ability handling heavy caseloads Intermediate Microsoft Word, Excel, and Outlook skills WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470 All Other Locations (within approved locations): $71,600 - $106,505 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.

Manager of Clinical Services - Utilization Management Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member. We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit *************************** for more information about the Amida Care culture. We are actively seeking a highly motivated, innovative and experienced individual to join our team as the Manager of Clinical Services - Utilization Management. Compensation will be commensurate with experience. Position Summary: The position of Manager of Clinical Services - Utilization Management provides clinical oversight of Utilization Management (UM) activities and staff within the Health Services Department. Monitoring functions include the development of auditing programs/audit tools and regular auditing of UM processes and cases, including all documentation and correspondence in line with regulatory guidelines. The Manager would interact regularly with delegated UM vendors. This position will also review medical utilization management denials and appeals prior to final determination by the Medical Director. Responsibilities: Provide regular oversight of Medical and Gender Affirming Services (GAS) UM processes ensuring all regulatory guidelines are followed. Track and process all medical/GAS UM appeals. Process all UM actions for Fair Hearing and External Appeals. Provide clinical review of Health Services complaints, working closely with the A&G department and the Manager of Clinical Services Operations. Develop and maintain comprehensive monitoring processes and tools related to authorizations, appeals, quality, case management, interrater reliability and data entry. Perform regular, proactive internal auditing to ensure that documentation, UM letters, controls and processes are appropriate and aligned with regulations and internal policies and procedures. Create monitoring reports, and follow up on findings and recommendations, i.e. length of stay reports. UM Point of contact for Medical Delegated vendor. Review all medical utilization management (UM) denials and appeals received from Medical UM vendor prior to final determination by the Medical Director. Review and process claims appeal as appropriate. Provide guidance, support and oversight into UM protocols, benefits and guidelines to the UM staff. Participate in the implementation and monitoring of corrective action plans from internal and external audits related to UM. Assist with report preparation for the Delegated Vendor Oversight and Quality Management Committees. Perform other duties as assigned. Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do. EDUCATION REQUIRED Registered Nurse (RN) license in New York State. EXPERIENCES AND/OR SKILLS REQUIRED 5 years' experience in a health plan offering Medicaid and/or Medicare Advantage plans. General knowledge of Medicaid Managed Care. Demonstrate intermediate PC skills using word, PowerPoint and Excel. Exhibit ability to work independently with attention to detail. Exhibit a strong commitment to objectivity. Exhibit a strong commitment to maintaining the integrity and effectiveness of the Health Services Department. Demonstrate interpersonal and verbal communication skills. Demonstrate ability to liaison with other departments. Demonstrate ability to research facts regarding compliance issues and incidents. Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts. Demonstrate appropriate behaviors in accordance with the organization's vision, mission, and values.

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member. We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit ****************************** more information about the Amida Care culture. We are actively seeking a highly motivated, innovative and experienced leader to join our team as the Compliance Manager. Compensation will be commensurate with experience. Position Summary: The Compliance Manager will work collaboratively with the Senior Director, Compliance/Compliance Officer and the Assistant Director Compliance/Privacy Officer to ensure compliance with all Medicaid regulatory requirements as well as compliance with internal Amida Care policies, where applicable. Responsibilities: Reviews the Monitoring Report and follow up for evidence of Monitoring with appropriate Business Units. Responsible for oversight of required regulatory reports and follow up for evidence. Assists with scrubbing and analyzing OMIG audit data and preparing initial draft response. Assists with Provider Investigative Report data gathering and input in HCS system. Assists with FWA tasks and other functions as needed. Responsible for tracking distributed Regulatory Requirements and responsible for getting status updates from appropriate business units. Assists with the preparation of materials for Article 44/49 full operational and targeted surveys. Assists with research regarding current or pending regulatory requirements as needed. Assists Sr. Director Compliance/Compliance Officer with Mental Health Parity meeting preparation and follows up on regulatory requirement/items. Tracks and monitors required follow-up with Vendor Management staff regarding identified vendor compliance issues. Assists with obtaining information for education and training materials. Provides assistance with regulatory inquiries from business areas. Assists with internal audits as needed. Assists with report preparation for Compliance Committee meetings and BOD meetings. Assists with PolicyStat tasks. Performs other duties as assigned. Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do. EDUCATION REQUIRED Bachelor's Degree or equivalent combination of education and relevant work experience. EXPERIENCES AND/OR SKILLS REQUIRED Five (5) years' experience in the field of Healthcare Compliance. General knowledge of Medicaid Managed Care. Efficient with MS Word, Excel, PowerPoint, Office. Exhibits ability to work independently with diligence. Exhibits a strong commitment to the integrity and effectiveness of the Compliance Department. Demonstrates ability to work collaboratively and effectively with all areas of the Company. Demonstrates interpersonal and verbal communication skills. Demonstrates ability to research facts regarding Compliance issues and incidents. Demonstrates understanding and sensitivity to multi-cultural values, beliefs and attitudes of both internal and external contacts. Demonstrates appropriate behavior in line with the Company's mission, vision and values.

*Great opportunity for any RN, nursing background - recent nursing grads and experienced nurses are all welcome to apply! This is a field based role. You will work in the field either a 4 day or 5 day work schedule. - •5k Sign-On Bonus Competitive salary & annual bonus • Field either 4 days10 hours or 5 days 8 hours work schedule. • No weekends/holidays/night shifts • 24 days of PTO, 29 days after 1 year of employment • Comprehensive benefit plan options • Extensive 4-6 week training program • Community based nursing • Dedicated, supportive & tenured team If you are passionate about what you do and want to work for a company that is focused on the future and dedicated to making a difference in people's lives, then Healthfirst is for you. As an Assessment RN you will visit members in their homes at intervals required by the Department of Health (DOH) and complete appropriate documentation to determine members' enrollment, service needs, and continued plan eligibility. This position coordinates with Care Management Team (CMT) to maintain efficient and effective operations of Healthfirst's long term care plans such as CompleteCare, FIDA, and Senior Health Partners. Duties and Responsibilities: RN Conducts assessments for prospective members and re-assessments of current members as well as identify enrollment and or eligibility by utilizing clinical expertise and critical thinking skills. As needed, conducts assessments in settings other than home e.g. skilled nursing facilities. RN conducts In-person Care Management visits in support of person-centered service planning. RN Completes assessment of members needs due to changing conditions. Reviews previous nursing assessments/medical notes to determine necessary adjustments/updates in Care Plan and/or to assist with nursing home placement eligibility. Coordination with home care agencies, vendors, pharmacies, medical providers and CMT regarding needs identified. Provides commnity based education for our frail population including self care and preventative care. Additional duties as assigned,including care management tasks as needed. Minimum Qualifications: New York State RN license. Ability to travel in and around Bronx, New York. Unexpired NY state driver's license or NYS ID Preferred Qualifications: Geriatrics Home Care Discharge Planning Case Management Medical Surgical Nursing Electronic patient health information (PHI) database experience Knowledge of health insurance, Medicaid, Medicare and MLTCP Experience working with a frail adult or elderly population with the ability to determine appropriate care plans and services for frail population as well as negotiate initial service plans so that members and families are in agreement Time management, critical/creative thinking, communication, and problem-solving skills Field experience assessing, planning, and evaluating member's/patient's care Demonstrated ability handling heavy caseloads Intermediate Microsoft Word, Excel and Outlook skills. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process. Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470 All Other Locations (within approved locations): $71,600 - $106,505 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.