Health First Remote jobs - 33 jobs

The Clinical Auditor performs audit functions for Healthfirst clinical teams (e.g. Care Management, Reassessment/Clinical Eligibility, Utilization Management, etc.) and delegated vendors and partners [within internal timeframes and deadlines] to determine operational efficiency, adherence to regulatory requirements, and achievement of quality standards. The audits may include but are not limited to listening to Care Manager phone calls; review of Uniform Assessment System (UAS) assessments, care plans, medical authorizations, and supporting documentation ensure compliance with regulatory requirements and internal policy; etc. Duties and Responsibilities: Maintains tracking tools to log audit results including areas of non-compliance and informing what areas of improvement are needed for discussion with management and/or at departmental team meetings Assists with evaluating and analyzing aggregate quality performance data Develops strategies for business performance improvement initiatives. This includes: identifying opportunities for improvement, problem prioritization, and creating performance improvement plans for non-compliant audits and/or reports Assists with creating and revising audit tools to ensure audits and reports are value-added Applies clinical and critical thinking skills to evaluate the quality and effectiveness of case management and/or utilization review decision-making Additional duties as assigned Minimum Qualifications: NYS LPN or RN license. In order to access the Uniform Assessment System (UAS), an unexpired NYS driver's license or NYS ID is required. If residing outside of NYS, the candidate must be able to obtain a NYS ID before commencement of employment. Preferred Qualifications: Relevant previous work experience such as medical records review; claims processing; utilization/case management in a clinical practice or managed care organization; managed care plan products (e.g. Medicaid, Medicare, Commercial) and knowledge of Department of Health (DOH) and Local Department of Social Services and Center for Medicare & Medicaid Services (CMS) regulations pertaining to managed care; nursing experience in an acute, sub-acute or long-term care (LTC) setting or managed long-term care plan (MLTCP, FIDA); Geriatrics, Medical Surgical Nursing, Case Management or Discharge Planning; etc. Experience working with any of the following systems: CareEnhance Clinical Management Software (CCMS), TrueCare, PEGA, Citrix, RightFax, VoIP, Virtual work platforms (VPN), Electronic medical record (EMR) database containing patient health information (PHI), and/or MACESS archival system. Language preferences - Spanish, Russian, French, Creole, Mandarin, Cantonese. Intermediate Microsoft Word, Excel, and Outlook skills Ability to build and maintain positive relationships with cross-functional teams and interact with all levels of management. Time management, critical/creative thinking, project management, communication, and problem-solving skills License or Certification: NYS LPN or RN license. Regulatory or Compliance activities: n/a 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 ********************, 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): $81,099 - $116,480 All Other Locations (within approved locations): $71,594 - $106,080 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.

Site: Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Summary: The role is responsible for the external vendor management, overseeing relationships, contracts, amendments, scope of work requests, vendor processes, analysis, and invoice submissions for the MGB Revenue Cycle Operations team. The position will also communicate with all business owners in the MGB RCO and collaborate with the strategy and innovation department. Does this position require Patient Care? No Essential Functions: Works closely with operational leaders to develop, recommend and establish strategies, plans and processes to understand and control external vendors. -Research and track vendor contract terms, alerting staff to renewal deadlines or extensions needed and documenting communications. -Maintain detailed records of correspondence and documentations of the entire contracting process, tracking and reporting on key projects including post-contract changes, amendments, and SOW fulfillment. < -Responsible for creating efficiencies, risk mitigation and vendor management. -Solve any contract-related problems that arise with guidance from MGB RCO leadership team. -Present information to key stakeholders about contract-related matters. -Develop and maintain vendor/contract management workflows. Qualifications Education Bachelor's degree required. Can this role accept experience in lieu of a degree? No Experience Vendor management 3-5 years required Knowledge, Skills and Abilities - Excellent communication and presentation skills both written and verbal with ability adjust to audience. - Strong management, problem-solving and organization skills. - Proven analytical aptitude, with the ability to create/extract/manipulate/analyze large amounts of complex financial and operational data. - Project management experience, with an ability to manage several projects simultaneously. - Ability to build collaboration across the organization. Additional Job Details (if applicable) Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $21.78 - $31.08/Hourly Grade 4 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Site: The General Hospital Corporation Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. LCSW: starting pay rate $68,224 LICSW: starting pay rate $92,227 SIGN ON BONUS AVAILABLE for eligible Non-MGB employees: $3,000 FOR LCSW, $10,000 FOR LICSW/LMHC, Please ask about the details! Job Summary Home Base, a Red Sox Foundation and Massachusetts General Hospital program, is dedicated to healing the invisible wounds - including post-traumatic stress, traumatic brain injury, anxiety, depression, co-occurring substance use disorder, family relationship challenges and other issues associated with Military service - for Veterans of all eras, Service Members, Military Families and Families of the Fallen through world-class clinical care, wellness, education, and research. The Massachusetts General Hospital seeks a dynamic Licensed Clinical Social Worker (LCSW)/Licensed Independent Clinical Social Worker (LICSW) to serve on the Special Operations Team. In this role, the LCSW/LICSW will provide and oversee the provision of psychiatric, psychosocial, and overall mental health services and referrals for military Special Operators into the Home Base program. They will also be dedicated to supporting the Special Operations Forces (SOF) program and will provide coverage to other clinical operations as needed. The LCSW/LICSW may help cover approximately 2-3 weekend shifts per year. Summary This position will collaborate with other professionals to evaluate patients' medical or physical condition and to assess client needs as part of the interdisciplinary team. They work collaboratively with all healthcare team members to develop and implement treatment plans that support patient-centered plans of care for both individual patients and the medical community. Does this position require Patient Care? Yes Essential Functions -Provides psychosocial assessments of patients and families with social, emotional, interpersonal, and/or environmental issues. Formulates biopsychosocial assessment, disposition, and treatment plans. -Collaborate with other professionals to evaluate patients' medical or physical condition and to assess client needs as part of the interdisciplinary team. -Monitor, evaluate, and record client progress according to measurable goals described in the treatment and care plan. -Coordinate care for Special Operations Forces (SOF) veterans and military-connected family members seeking care at Home Base with the appropriate internal or external clinicians in a multi-disciplinary team, coordinated care model. -Serve as a contact point for accepting and triaging SOF referrals from internal clinicians, outside clinicians and self-referred patients. -Serve as primary case manager for patients in SOF admissions process in collaboration with Admissions Coordinator, including, but not limited to, the following responsibilities: conduct pre-screening to assess treatment and evaluation needs for SOF patients referred; coordinate signing of Release of Information forms, acquire relevant medical records, and coordinate with SOCOM where applicable; serve as point of contact for ongoing questions from the patient as they arise. -Monitor patient's status in admissions process using appropriate documentation. -May be asked to collaborate with SOF/ComBHaT team, patients, clinical team, and Resource Specialist to identify clinical and psychosocial needs in patients' home communities and identify appropriate resources. -May provide direct clinical services to Veterans and/or family members, which may include group or individual therapy. -May provide psychoeducation regarding PTSD, TBI, and related conditions to Veteran patients and family members as clinically appropriate within the context of the Intake and triage duties. -Collaborate with an inter-disciplinary team of clinical staff (social workers, psychologists, nurses, psychiatrists, physiatrists, physical therapists, etc.) to coordinate patient care and plan for discharge/aftercare when needed. -Consult with team to facilitate mandated assessments when abuse is suspected (child, disabled adult, elder), and safety assessment when violence is reported. Collaborates with MGH resources (HAVEN and Child Protection Team). -May assist with crisis intervention and management. -Documents timely and relevant information in patient electronic medical record and Home Base database. -Provide coverage for social work responsibilities in Outpatient Clinic as needed. -For LICSWs: provide clinical supervision to LC-level and/or MSW students as needed. -Additional responsibilities as assigned. Qualifications Education Master's Degree Social Work required or Master's Degree Mental Health & Behavioral Medicine required Can this role accept experience in lieu of a degree? No Licenses and Credentials Current professional licensure in Massachusetts (LCSW required, LICSW preferred). Experience Clinical Social Worker I Clinical Experience in a medical setting 0-1 years required Clinical Social Worker II Clinical Experience in a medical setting 2-3 years required Knowledge, Skills and Abilities - Excellent organizational and time management skills. - Excellent crisis intervention skills. - Good problem solving and conflict resolution skills. - Ability to work well collaboratively and independently. - Strong written and verbal communication skills. - Knowledge of community resources and the aging process. - Demonstrates basic foundational skills, showing fundamental knowledge and a commitment to the application of professional values and ethics. - Demonstrates fundamental skills in formulation, assessment of risks, crisis intervention completion of psychosocial treatment plans, and appropriate documentation. - May need assistance and guidance in ensuring the patient's needs, safety measures, and concerns are brought forward. Emerging knowledge of internal and external resources. - Developing and demonstrating interpersonal collaboration in a medical setting- inpatient or outpatient. - May need coaching/guidance in this area. - May provide some assistance and support with onboarding for new team members. - Aware of opportunities in department/service initiatives; participates in initiatives at an entity level. Uses data to measure progress. - Demonstrate fundamental skills under supervision. May need assistance in promoting collaboration among healthcare team members, other colleagues, and the organization to support and enhance patient care. Additional Job Details (if applicable) Physical Requirements Standing Frequently (34-66%) Walking Frequently (34-66%) Sitting Occasionally (3-33%) Lifting Frequently (34-66%) 35lbs+ (w/assisted device) Carrying Frequently (34-66%) 20lbs - 35lbs Pushing Occasionally (3-33%) Pulling Occasionally (3-33%) Climbing Rarely (Less than 2%) Balancing Frequently (34-66%) Stooping Occasionally (3-33%) Kneeling Occasionally (3-33%) Crouching Occasionally (3-33%) Crawling Rarely (Less than 2%) Reaching Frequently (34-66%) Gross Manipulation (Handling) Frequently (34-66%) Fine Manipulation (Fingering) Frequently (34-66%) Feeling Constantly (67-100%) Foot Use Rarely (Less than 2%) Vision - Far Constantly (67-100%) Vision - Near Constantly (67-100%) Talking Constantly (67-100%) Hearing Constantly (67-100%) Remote Type Hybrid Work Location One Constitution Wharf Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $56,992.00 - $82,992.00/Annual Grade 6 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: The General Hospital Corporation is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Site: Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary Mass General Brigham Health Plan UM Medical Director Qualifications Education: MD or DO required Licenses and Credentials: Physician - Massachusetts active full license required Experience: 5+ years of Health Plan UM experience at least 5 years of clinical practice experience Knowledge, Skills and Abilities: Utilization Management experience Excellent written and oral communications skills Proficient in basic computer skills, use of EHR's, digital tools Multitasking abilities Adaptable to change due to business growth Job Description: Handles utilization management initial determinations, appeals and grievances within the scope of their expertise as defined by Medicare, MassHealth, NCQA and the Division of Insurance and within the compliance requirements of key regulatory and accreditation entities Use CMS, state and internal medical necessity policies to guide MN determinations Complete peer to peer case discussions with requesting providers as assigned Refer to IRO/external review if specialist match or expertise is needed Interact, communicate and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees Monitors performance metrics to identify areas for continuous improvement and ensure compliance Establishes and maintains positive relationships with colleagues and customers and gains their trust and respect Ensure diversity, equity and inclusion are integrated as a guiding principle Other duties as assigned with or without accommodation Additional Job Details (if applicable) Primarily remote position M-F 830-5pm EST Ensures that all assigned work is completed within regulatory timelines Checks and addresses assigned work queues, email, Teams messages during assigned work hours Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 0 Employee Type Regular Work Shift Day (United States of America) EEO Statement: Balance Sheet Cost Centers is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

Site: Mass General Brigham Incorporated Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Job Summary General Summary: Under the general direction of the Director of Risk Capture, the Pre-Visit Clinical Review Specialist (CRS) facilitates the accurate and appropriate identification of patient medical conditions through comprehensive chart review combined with review of coding output data sources (internal and external claims) that results in improvement in the overall quality, completeness and accuracy of problem lists, visit documentation and disease registry assignments. The CRS utilizes both clinical and coding knowledge of Hierarchical Condition Categories (HCCs) to inform accurate and appropriate diagnosis considerations for suspect condition identification and recapture opportunities. This role serves to educate providers and the clinical care team on all aspects of risk capture and linkages with quality. Qualifications Principle Duties: Drive Clinical Delivery Performs accurate and timely pre-visit review of selected ambulatory encounters to identify opportunities to recapture medical conditions that meet criteria as HCC diagnoses and to capture new, suspected HCC conditions. Accurately interprets clinical information in the medical record, evaluating clinical indicators to identify potential diagnoses Presents clear HCC Consideration Communication to provider and educates providers to obtain greatest possible diagnostic specificity to accurately reflect the patient's condition(s) Identify Education Opportunities Identifies themes through chart review that might present education opportunities for individual or groups of providers Gathers feedback from periodic post-visit chart reviews and incorporates these learnings into educational opportunities with providers Identifies opportunities for Process Improvement and Quality Improvement, as needed Foster collaborative relationships across the enterprise Communicates appropriately and compliantly with physician or care team through Epic resources to improve medical record documentation Participates in ambulatory unit/organizational programs and meetings as needed Maintains professional competency by keeping abreast of new coding issues and guidelines. Attends classes and meetings as assigned. Reviews professional CDI and coding literature regularly Maintains clinical licensure and/or medical coding credentials (e.g. RN, PA, NP, CRC, CDEO, CCS, CPC) and completes all required Organizational Competencies and trainings (if applicable) Meets with providers on an as-needed basis to address concerns or areas of opportunity, and performs chart reviews as needed Maintains good rapport and professional relationships, as outlined in MGB Code of Conduct - Approaches conflict in a constructive manner, helps identify problems, offers solutions and participates in resolution Responsible to perform any other assigned duties as requested Qualifications: Minimum three (3) - five (5) years' experience required in either, case management, outpatient coding, utilization review, CDI or other disciplines with either coding experience however, an equivalent combination of education and experience, which provides proficiency in the areas of responsibility, may be substituted for the stated education and experience requirements. 2 years' experience in Primary Care, medical coding, risk adjustment or CDI preferred Current certification in Clinical Documentation Improvement (CDIP, CCDS, CCDS-O or CDEO) preferred Certification in medical coding and or risk adjustment (i.e., CRC, CPC, CCS, CDEO, or CCS-P or other pertinent to outpatient) preferred (CRC Required training within 1 year of employment) Medical licensure (RN, PA, NP) preferred Bachelor's degree healthcare related preferred Strong PC skills / Microsoft applications, including Outlook, Teams, Excel, PowerPoint Additional Job Details (if applicable) Remote Type Remote Work Location 399 Revolution Drive Scheduled Weekly Hours 40 Employee Type Regular Work Shift Day (United States of America) Pay Range $62,400.00 - $90,750.40/Annual Grade 6 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package. EEO Statement: 0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at **************. Mass General Brigham Competency Framework At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

The Healthfirst Credentialing department credentials and re-credentials providers, facilities and vendors; prepares hard-copy directories and reviews network provider data for accuracy and ensures compliance with regulatory requirements and federal and state regulations. Duties/Responsibilities: Credentials providers, facilities, and vendors in accordance to regulations and Healtfirst policy. Prepares presentations for the quarterly credentialing and delegate vendor oversight committee meetings. Facilitates pre-delegation and delegation vendor audits to ensure adherence to contractual arrangements. Prepares hard-copy directories and works with third party vendors for posting online directories. Reviews relevant data to ensure accuracy. Effectively communicates to internal departments and external partners. Identifies and assesses opportunities to improve processes to better ensure regulatory compliance and adherence to state and federal regulations. Raises issues to management and assists in resolution. Additional duties as assigned. Minimum Qualifications: HS diploma/GED Preferred Qualifications: Bachelor's degree Prior relevant experience Time and project management, critical/creative thinking, communication, and problem-solving skills. Intermediate Microsoft software skills include Adobe, Access, Excel, Word, PowerPoint, and Office 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 ********************, 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.

The Program Coordinator, Reward Card Program in Clinical Quality is responsible for supporting Healthfirst initiatives and regulatory requirements related to Member Rewards and Incentives, HEDIS Quality Improvement, Medicare Stars and Member Satisfaction. This position is both internal (EDS, Marketing, etc.) and external (Members, Provider, Vendor) facing.Duties & Responsibilities: Verifies reward requests based on required preventive services appropriate for the member's age, gender and other accepted demographics as outlined via the Member Reward Card Program Guidelines, HEDIS/QARR Technical Specifications, and CMS/DOH guidelines Conducts member and provider outreach to inform on reward guidance and status using multiple internal systems and applications Collaborates with internal and external teams to track and document program requirements and implementation status Documents, communicates and presents technical improvement findings and recommendations in all systems supporting Member Rewards Program Provides support in creating, editing and communicating member and provider material updates Additional duties as necessary Minimum Qualifications: High School/GED Diploma from an accredited institution Basic knowledge of MS Word, Excel, Access, and Outlook Strong organizational skills Good communication (verbal and written) and interpersonal skills Flexibility, reliability, and easily adaptable to any work assignments or new computer applications Competent in managing responsibilities in a high-volume and fast-paced environment Ability to resolve member issues with patience and courtesy Preferred Qualifications: Associate's degree from an accredited institution + 2 Years Work Experience. Experience processing reward card requests highly preferred. Bilingual in English and one or more language(s): Spanish, Mandarin, Cantonese may be required based on business needs Familiarity with some medical terminology. Experience addressing member inquiries in a managed care environment. Knowledge of CPT and ICD-9 codes. Compliance & Regulatory Responsibilities: Noted above 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 ********************, 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): $40,200 - $54,570 All Other Locations (within approved locations): $34,900 - $52,000 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.

We are recruiting for a motivated Senior Data Analyst, HEDIS - Denver Health Medical Plan (Must Be A Colorado Resident) to join our team! We are here for life's journey. Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all: Humanity in action, Triumph in hardship, Transformation in health. Department Managed Care Administration *Must Be A Colorado Resident Job Summary The Senior HEDIS Data Analyst is responsible for the comprehensive analysis, validation, and reporting of Healthcare Effectiveness Data and Information Set (HEDIS) measures for Denver Health Medical Plan. This position plays a key role in driving performance improvement through rigorous data analytics, identification of trends and opportunities, and the development of actionable insights. The Senior Analyst collaborates with clinical, operational, and technical teams as well as vendors and auditors to ensure accurate and timely reporting, regulatory compliance, and strategic execution of HEDIS initiatives across all product lines. Essential Functions: Lead end-to-end HEDIS project data support, including data extraction, transformation, validation, and submission in accordance with NCQA technical specifications and regulatory timelines. (0%) Analyze HEDIS measure performance across Medicare, Medicaid, Exchange and Commercial lines of business; identify performance trends and root causes of underperformance. (0%) Present findings and recommended actions to leadership and stakeholder teams (10%) Partner with internal stakeholders, such as Quality Improvement, Population Health, Clinical Operations, HEDIS Team and IT, to support interventions aimed at improving HEDIS outcomes and identifying additional sources to obtain data. (10%) Design and develop dashboards and reports that provide actionable insights to both technical and non-technical audiences. (10%) Develop methods and workflows to improve data mapping and accuracy, generation of performance reports, identification of gaps in care, and methods to identify new data sources, including processes to assist in the transition to FHIR (Fast Healthcare Interoperability Resources) standards. (10%) Serve as primary data liaison external vendors and auditors to ensure completeness and accuracy of medical record review and supplemental data integration to support HSAG, HCPF, CMS, NCQA submissions. (10%) Responsible for timely submission of the Annual NCQA HEDIS ROADMAP, HEDIS Audit, IDSS and related data submissions including the closure of Issue Log items and performing benchmarking of collected data. (10%) Serves as subject matter expert on HEDIS data methodologies, including Hybrid, Administrative and Electronic Clinical Data Systems (ECDS) collection methods. (10%) Work with Denver Health and Hospital Authority to optimize data in structured data fields in Epic EHR to support ECDS (10%) Validate source system data and perform quality assurance checks to ensure data integrity for HEDIS and other quality reporting programs. (10%) Stay current on NCQA guidelines, CMS and state-specific requirements, and industry best practices. (5%) Support the development of standardized analytics tools and processes. (5%) Education: Bachelor's Degree public health, Health Informatics, Statistics, Computer Science, or a related field required Master's degree preferred Work Experience: 4-6 years experience in health care data analytics, with at least 3 years focused specifically on HEDIS or quality measurement reporting in a health plan or similar environment required Licenses: Knowledge, Skills and Abilities: Strong knowledge of NCQA HEDIS specifications, CMS Star Ratings, and regulatory reporting to State and Federal programs. In-depth knowledge of HEDIS lifecycle, including NCQA IDSS tool usage. Familiarity with data from clinical systems (e.g., EMR/EHR), claims, encounters, and supplemental data sources. Excellent problem-solving, communication, multi-disciplinary collaboration and project management skills. Proficiency in Microsoft Office (Excel, PowerPoint, Word). Accuracy and attention to detail in data analysis and reporting. Proven ability to meet deadlines and manage deliverables. Ability to work independently and manage multiple competing priorities in a fast-paced environment. Experience with HEDIS software tools (e.g., Inovalon QSI-XL, Cotiviti, OnPoint, or other vendors), preferred Experience working with Medicaid, Exchange, Medicare Advantage, or Dual Eligible populations, preferred Knowledge of risk adjustment, care gaps, or other quality-related initiatives such as CAHPS or Health Outcomes Survey (HOS), preferred Advanced proficiency with SQL (Oracle, SQL Server, or similar), with experience writing complex queries and optimizing data pipelines, preferred Experience using reporting and data visualization tools (e.g., Tableau, Power BI, SAS, R, Python), preferred CPHQ (Certified Professional in Healthcare Quality) certification, preferred *This is a hybrid role, with a requirement of being in the office 1-2 days per week. Shift Days (United States of America) Work Type Regular Salary $84,000.00 - $130,200.00 / yr Benefits Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans Free RTD EcoPass (public transportation) On-site employee fitness center and wellness classes Childcare discount programs & exclusive perks on large brands, travel, and more Tuition reimbursement & assistance Education & development opportunities including career pathways and coaching Professional clinical advancement program & shared governance Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer Our Values Respect Belonging Accountability Transparency All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation. As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year. Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer. Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. Applicants will be considered until the position is filled.

Community Association General Manager: Job Summary: We are seeking an experienced Florida Licensed Community Association Manager for the on-site General Manager position role in one of our premier properties. The General Manager is responsible for providing the overall supervision of the Community, including, but not limited to, property inspections & overall property maintenance, vendor & contract management, budgeting & invoice processing, interacts with internal and external customers including homeowners, vendors, board members and committee members. This position will also oversee the onsite food and beverage operations. Performs all duties in accordance with company policies, processes, and procedures and within the realm of the management philosophy. Essential Duties & Responsibilities The job duties listed are typical examples of the work performed by positions in this job classification. Not all duties assigned to every position are included, nor is it expected that all positions will be assigned every duty. Supervise the operation and administration of the community association in accordance with management agreement and the Association's policies and procedures. Acts as or oversee the primary liaison with the Association Board of Directors and homeowners as needed. Perform/Direct administrative and management duties as requested by the Board of Directors and in accordance with the management agreement. Ensure community management tools are being effectively developed and utilized such as annual calendar, action item list, resolution worksheets, timed agendas, RFP matrixes, committee charters, procurement procedures, operating budget, etc. Review monthly financial reports and ensure management summary is submitted to the association Board of Directors. Conduct CC&R Inspections, generate violation notices and enforcement process. Provide and/or oversee recommendations to the Association Board of Directors and committees regarding major capital expenditures as required to maintain the desired community appearance and operation. Monitor delinquency rates and collections process. Attend Board meetings per the management agreement and community events as needed. Prepare Board packages according to established time frames. Ensure Board of Directors are aware of legal actions involving the Association. Maintain unit and contract files relating to the operations of the Association. Assist Board of Directors/ARB with architectural review process and/or routine inspections as necessary. Responsible for maintenance of records data base, including updating resident information. Responsible for routine and special project vendor management including procurement as well as performance evaluation as contracted. Coordinate and/or oversee inspection of building facilities and/or common area and arrange appropriate follow up actions as required. Oversee the AP process in accordance with home office processes and procedures. Working with the executive chef and front of the house manager on food and beverage operations. Other duties as assigned. Additional Duties and Responsibilities Practice and adhere to Access Management's Service Standards. Conduct business at all times with the highest standards of personal, professional and ethical standards. Perform or assist with any operations as required to maintain workflow and to meet schedules. May participate in any variety of meetings and work groups to integrate activities, communicate issues, obtain approvals, resolve problems, and maintain specified level of knowledge pertaining to new developments, requirements, policies, and regulatory guidelines. Ensure all safety precautions are followed while performing duties. Follow all policies and Standard Operating Procedures as instructed by Perform any range of special projects, tasks and other related duties as assigned . Education & Experience Current Florida Community Association Manager License Required A minimum of 5 years actively managing Community Associations (HOA/COA/POA) A strong background in special project management is preferred. Hospitality experience preferred. Knowledge, Skills & Proficiencies To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Excellent people skills. Strong knowledge of Microsoft Applications, Vantaca software experience preferred. Excellent written and verbal communication. Ability to make sound business decisions and work effectively with little or no supervision. Strong Time Management. Strong Problem Solving and Conflict Management Ability to successfully work with a wide range of personnel including vendors, personnel, office staff and all levels of management Tools & Equipment Company issued laptop, mobile phone & vehicle reimbursement allowance, printer, office equipment. Physical Requirements/Working Environment The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to lift 25 lbs. Must be able to sit for extended periods of time. Must be able to stand for long periods of time and be able to freely move about the office. Must be able and willing to work a variety of hours in order to meet the requirements of the position, including evenings, weekends, and holidays. The work environment characteristics are normal office conditions at an onsite community facility. This is a full-time position. There will be occasions when it is necessary to work various evenings, weekends, and holidays. Consistent and regular attendance required however the position is flexible and candidate can work remotely part of the time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Hours over and above normal office hours will occur, including evenings, holidays, and some weekends. Schedule is subject to change based on business needs. Disclaimer The above information on this description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job. This is not an all- inclusive job description; therefore, management has the right to assign or reassign schedules, duties and responsibilities to this job at any time. Job Type: Full-time

**Scope of Responsibilities** **:** + Conduct quality audits of A&G items including grievances, pre-service appeals, and post service appeals utilizing appropriate sources of information; including eligibility, claims, authorizations, service forms, faxes, and any additional information required to complete the request. Analyze errors and determine root causes for appropriate classification, trending, and remediation. + Record/track quality assessment scores and provide feedback to reduce errors and improve processes and performance to ensure quality. + Review and investigate appeals and grievances requests to ensure all requests are identified, classified, and fully resolved in a compliant manner. + Present results of investigations to senior staff and prepare written reports concerning investigation activities. + Subsequent auditing and handling of specific appeal and grievance requests including processing where applicable, tracking, documenting, reporting and dispersal of findings and recommendations. + Identify defects and improve departmental performance by supporting quality, operational efficiency and production goals. + Assist in the development of departmental policies and procedures; reviews the efficiency of existing training. + Meet established time frames and rates of performance for the quality and quantity of work for the position. + Participate in regulatory and mock audit activities including universe review, universe scrubbing, risk analysis, timeliness assessment, and case walkthrough activities + Additional duties as assigned **Minimum Qualifications** **:** + Experience with the investigation, resolution, and reporting of appeal and grievance processes. + Experience in Microsoft Office suite of applications including Excel (formatting formulas, managing data, and filtering results), Word (creating and editing documents), PowerPoint (creating and editing presentations). + High School Diploma or GED from an accredited institution. **Preferred Qualifications** **:** + Associate degree from an accredited institution. + ICD10 certification. + Experience in an Auditing capacity conducting root cause analysis. + Knowledge of at least two or more lines of business such as Medicare NY/NJ, Medicaid, Family Health Plus, Child Health Plus, NH Family. + Experience handling confidential information. + Compliance & Regulatory Responsibilities: Knowledge of state and federal appeal and grievance regulatory requirements. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, 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.

The Clinical Pharmacist is responsible for efforts to support quality measures for both our Essential Plan and Medicare populations. The Clinical Pharmacist conducts provider and member outreach to address gaps in care measures, support medication adherence initiatives, and assist with strategies to improve quality measures, all while maintaining compliance with all Federal and State agencies. This is a dynamic position requiring the Clinical Pharmacist to stay current with literature, evidence-based medicine, and trends in medicine.Job Description - 100% Remote - MTM - Bilingual Spanish Duties & Responsibilities: Support initiatives to resolve gaps in care through direct provider and member outreach, collaboration with provider engagement, and leveraging our pharmacy network capabilities Ensure that all recommendations are consistent with the latest guidelines or otherwise supported by the clinical compendia Provide clinical pharmacy support to pharmacy technicians as they conduct outreaches to members regarding med adherence, resolve existing barriers to adherence, and use motivational interviewing to improve the health of our members Collaborate internally with Marketing, IT, and Enterprise Analytics to assist with the creation of strategic digital communication channels for member outreach Identify and resolve same-day grievances reported by members in a timely manner consistent with our policies and procedures Oversee and maintain compliance with all State and Federal agencies Precept Pharmacy Residents and Students Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH) Research drug information to maintain drug knowledge and disease state understanding Review monthly reports and provide feedback on trends, ideas for efficiency, and innovation Additional duties as assigned or required Minimum Qualifications: Pharmacy degree from an accredited school of pharmacy Registered Pharmacist, with a state license in good standing Work experience requiring written and verbal clinical communication that is clear, concise, grammatically correct, and professional Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits Preferred Qualifications: Bilingual fluency in English and Spanish. Ability to work well in a team environment and be a team player Demonstrated critical thinking and problem-solving skills Passion for learning, promoting the profession of pharmacy, and interest in growing skills in a dynamic environment with various opportunities Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations Ability to lead large and small working meetings PC Skills with Microsoft Outlook, Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables) Compliance & Regulatory Responsibilities: Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations. License/Certification: Licensed pharmacist in good standing 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 ********************, 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.

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 ********************, 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.

The Care Manager plans and manages behavioral and/or physical care with members and works collaboratively with them, their supports, providers, and health care team members. The Care Manager is responsible for applying care management principles when engaging members and addressing coordination of their health care services to provide an excellent member experience, address barriers, and improve their health outcomes. The Care Manager is assigned to a specific product line such as CompleteCare, SNP, Medicaid/Medicare, PHSP, HARP, etc. Duties and Responsibilities: Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. Conducts assessments to identify barriers and opportunities for intervention. Develops care plans that align with the physician's treatment plans and recommends interventions that align with proposed goals. Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement and maintenance of successful health outcomes. Liaise between service providers such as doctors, social workers, discharge planners, and community-based service providers to ensure care is coordinated and care needs are adequately addressed. Coordinates and facilitates with the multi-disciplinary health care team as necessary to ensure care plan goals and treatment is person-centered and maximizes member health outcomes. Assists in identifying opportunities for alternative care options based on member needs and assessments. Evaluates service authorizations to ensure alignment and execution of the member's care and physician treatment plan. Contributes to corporate goals through ongoing execution of member care plans and member goal achievement. Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate. Occasional overtime as necessary. Additional duties as assigned. Minimum Qualifications: For Medical Care Management: NYS RN or LCSW or LMSW (any state) 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 For Behavioral Health (BH) Care Management: NYS RN or LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state) 3 years of work experience in a mental/behavioral health or addictions setting For BH 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: Strong interpersonal and assessment skills, especially the ability to relate well with seniors, their families, and community care providers, along with demonstrated ability to handle rapidly changing situations. Fluency in Fujianese Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors. Experience managing member information in a shared network environment using paperless database modules and archival systems. Experience and knowledge of the relevant product line Relevant work experience preferably as a Care Manager Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems 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 ********************, 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): $81,099 - $116,480 All Other Locations (within approved locations): $71,594 - $106,080 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 UM Pharmacy Technician is responsible for the intake and review of prior authorization requests for medications requested under the medical benefit. The UM Pharmacy Technician makes approval decisions and denial recommendations based on predetermined clinical criteria. They establish rapport with Provider offices and leverages strong communication and customer service skills when providing updates and delivering decision notifications to members and providers, The UM Pharmacy Technician position is part of multidisciplinary team and works closely with Providers, Pharmacists, and Medical Directors. Duties & Responsibilities: Reviews prior authorization requests and units for medications requested under the medical benefit Assesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria Sends notification to members and providers of authorization decisions via telephone, fax, or mail Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH Establishes great rapport with Provider offices via telephonic communication Sends request for information sheets to Providers Ensures that patient information is shared appropriately maintaining confidentiality and compliance with federal law and HIPAA regulations Additional duties as necessary Minimum Qualifications: High School Diploma or GED from an accredited institution Either nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or licensed Pharmacy Technician in good standing Experience conducting prior authorization reviews Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional Preferred Qualifications: Strong written and verbal communication skills in Chinese, Spanish, or Russian Demonstrated critical thinking and problem-solving skills Team player with a passion for learning and interest in growing skills in a dynamic environment with various opportunities Knowledge of specialty pharmaceuticals and billing practices in the medical benefit Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables). Experience with TruCare Care Management Platform Compliance & Regulatory Responsibilities: Noted above License/Certification: Nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or a licensed Pharmacy Technician in good standing. 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 ********************, 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): $47,403 - $64,338 All Other Locations (within approved locations): $41,101 - $60,320 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 Performance Support Specialist will be responsible for providing assistance in resolving complaint issues escalated by the representatives. This role is required to pull non-urgent complaint reporting through various systems on a daily basis, review each matter and reach out to the member in order to provide determinations while maintain a tracking system for any and all incoming complaint issues. Duties & Responsibilities: Assist in resolving customer complaints escalated by internal and external business partners as needed. Assist in reviewing and modifying Physician capitation reports. Assist in resolving member issues who called in multiple times with the same issues. Assist in responding and resolving escalated inquiries from other departments and external contacts. Make recommendations on process improvements. Build sustainable relationships of trust through open and interactive communication with internal and external customers. Able to properly follow procedures based on issues and documents received Make recommendations to management concerning staff performance. Make recommendations on process improvement. Maintain open exchange of information with external and internal customers. Required to multi-task, prioritize and manage time effectively. Timely filing of complaints. Conduct outreaches as required. Attend meetings as business requires. Additional duties as assigned. Minimum Qualifications: High School Diploma or GED from an accredited institution Healthcare industry experience Experience working in customer service Excellent telephone & customer service skills Experience working in clerical or administrative capacity Experience meeting strict deadlines Proficient in Microsoft suite of applications including Word, Power point, Outlook and Excel. Preferred Qualifications: Associate degree from an accredited school Conflict Resolution Experience Experience handling complex situations and/or projects Experience in developing and coaching of staff Compliance & Regulatory Responsibilities: NA License/Certification: NA 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 ********************, 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): $47,403 - $62,400 All Other Locations (within approved locations): $41,101 - $60,320 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.

A vital role of the CMO Administration team, the Medical Peer Reviewer plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to internal Healthfirst and external regulations. Duties/Responsibilities: The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations. The Medical Peer Reviewer will render determinations in the format and within timeframes to follow Regulatory and Operational policies. The Medical Peer Reviewer will: Maintain productivity standards. Collaborate with Utilization Management and Care Management and medical departments as needed, reviews and manages cases/caseload from multiple lines of businesses Demonstrate the ability to be flexible when case load volume fluxes and when Leadership requests changes in case priorities to support our members/internal medical departments as needed Complete mandatory Company compliance training and training in new systems and software. Enter each day's hours worked in Workday, on the same day. Perform other duties as assigned Responsibilities may be adjusted based on changing needs of the organization. Weekday Requirements: The Medical reviewer requires 25 hours a week of coverage/5 days per week. Each Medical Reviewer will cover one legal holiday /year and will be compensated Holiday pay and straight hours worked The Medical Reviewer is eligible for Paid Time Off (PTO) and is required to plan and schedule time off with their direct supervisor following the Company policy. Weekend Requirements: Each Medical Reviewer is required to be primary coverage one weekend a month Each Medical Reviewer is required to be available as back up, if needed, one weekend a month . Minimum Qualifications: Licensed M.D. or D.O. or D.M.D. or D.D.S. Board Certified in a specialty recognized by the American Board of Medical Specialties Preferred Qualifications: New York State Board Certified in Internal Medicine or Family Practice Previous, relevant experience in utilization management and clinical practice Knowledge of Medicare, Medicaid, and MLTC plans Time management, critical thinking, communication, and problem-solving skills Knowledge of UM/QM case philosophies and reporting requirements to state and federal agencies Knowledge of member satisfaction/incident management and regulations Knowledge of quality improvement methodologies Compliance & Regulatory Responsibilities: Ensures compliance to internal Healthfirst and external regulations. Licensed M.D. or D.O. or D.M.D. or D.D.S. Annual Compliance and other training as assigned, may include but not limited to hardware, software, and system training upgrades Annual Inter-Rater Reliability (IRR) Testing Complies with the Healthfirst Conflict of Interest Policy for Professionals 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): $122,907 - $188,020 As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

We are recruiting for a motivated IT Security Analyst II to join our team! We are here for life's journey. Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all: Humanity in action, Triumph in hardship, Transformation in health. Department Information Technology-Biomed Job Summary The IT Analyst Security II is responsible for multiple day-to-day security tasks and various information security projects as part of supporting the organization's information security needs. Day-to-day tasks include incident response, evaluation of requests for security changes, and monitoring of various security devices and audit logs. Responsibilities also involve providing ongoing support and advice to IT staff and end users on a variety of security issues, and ensuring that Denver Health's security policy and procedures are adhered to. Essential Functions: In collaboration with infrastructure application teams and external department system administrators, implements and monitors organizational IT security policies and procedures, ensuring technical controls are enforced. (10%) Works with IT department managers and staff to ensure security issues are addressed as new equipment, facilities, systems, and software are installed. (10%) Develops processes for routine and requested internal audits of systems, applications, and data access including tools and techniques used to conduct audits. (5%) Conducts or coordinates audits on predefined schedule and when an audit is requested or indicated as part of an investigation. (5%) Documents audit findings and follows-up on access irregularities. (5%) Follows procedures and industry best practices for reporting and investigating IT related security incidents. (5%) Investigates and documents all reported or suspected security incidents. Maintains documentation of investigations and provides reports to the Chief Information Security Officer. (5%) Recommends implementation of corrective actions needed to mitigate security vulnerabilities. (5%) In coordination with Network/Server and Applications, develops procedures and technical controls to monitor appropriate administrator, end-user, vendor, and remote access to the Denver Health network, and IT systems. (5%) Investigates alerts to ensure that information is not altered or lost during storage, or transmission. (5%) Collaborates with the Project Management Office (PMO) on initiatives involving the IT Security program. (5%) Provide monthly metrics to the CISO and the IT Director of Information Security by the 3 rd business day of each month. (5%) Monitor and respond to help desk tickets within the documented Service Level Agreements (SLA). (5%) Maintain current documentation for all procedures and applications currently in use. (5%) Respond to all on-call notifications within required documented SLA's. (5%) Responsible for periodically updating management, via written or verbal reports, on all issues, concerns, or problems related to the IT Security program. (5%) Monitors changes to applicable laws, industry standards, and regulatory or accreditation requirements, and incorporates requirements into the organization's IT Security program. (5%) Plans and organizes time effectively. Integrate priority changes into work plans. Anticipates resource needs and plans accordingly. (5%) Education: Bachelor's degree required or a minimum of 5 years of IT experience required. At least one IT Security certification (i.e. CompTIA Security+) required. Work Experience: 4-6 years required. Knowledge, Skills and Abilities: Familiarity with regulations and compliance issues, preferably within the healthcare industry Demonstrated ability to drive multiple requirements across systems, users, and workflows Demonstrated ability to communicate with technical and non-technical stakeholders across the organization Working knowledge of IT Security tools and solutions Demonstrated ability to recognize and respond to alerts or other behaviors to quickly detect and mitigate potential threats Demonstrated ability to mentor, educate, and train other team members Familiarity with advanced networking concepts (i.e., TCP/IP) Strong understanding of Microsoft Windows desktop and server operating systems Familiarity with Linux operating systems Advanced knowledge of Web Security Solutions Advanced knowledge E-Mail Security Solutions Advanced knowledge of Security Incident Event Management (SIEM) systems Advanced knowledge of Vulnerability Management Advanced knowledge of security architecture including NIST, OWASP, etc. Shift Days (United States of America) Work Type Regular Salary $77,900.00 - $120,700.00 / yr Benefits Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans Free RTD EcoPass (public transportation) On-site employee fitness center and wellness classes Childcare discount programs & exclusive perks on large brands, travel, and more Tuition reimbursement & assistance Education & development opportunities including career pathways and coaching Professional clinical advancement program & shared governance Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer Our Values Respect Belonging Accountability Transparency All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation. As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year. Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer. Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. Applicants will be considered until the position is filled.

The RN or SW Clinical Facilitator coordinates with Clinical Teams and other internal stakeholders to advance Healthfirst's clinical practice through technical assistance, education, and innovation solutions by applying adult learning theory. The technical assistance solutions will ensure efficient and effective quality of care in accordance to Healthfirst standards and rules/regulations set forth by state, and federal regulatory and compliance agencies. Within the Clinical Division at Healthfirst, the Clinical Technical Assistance Center (CTAC) will assist clinical employees and other internal stakeholders in tactically obtaining or improving the essential knowledge or skills needed to perform their jobs. The CTAC will also serve as the hub for ongoing adult learning and skills acquisition which supports Healthfirst's commitment to ensuring its teams are capable, engaged, and committed to their work.Leverages adult learning principles and clinical practice standards to move towards a culture of continuous technical assistance improvement and clinical capacity building with innovative learning solutions. Develops technical assistance goals that are congruent with the organization and the Clinical Department's mission, vision, and strategic direction. Provides technical assistance, resources and tools that define performance requirements, identify gaps between existing and required performance, analyze root causes that limit performance and recommend and/or implement learning solutions that focus on and deliver business results. Utilizes current literature, research, and evidence-based findings in the design, implementation and evaluation of technical assistance solutions and education programs for staff learning and development. Conducts onboarding, preceptorship, and ongoing professional training to ensure clinical staff are equipped to perform job responsibilities in accordance to Healthfirst standards and rules/regulations set forth by regulatory and compliance agencies. Facilitates with subject matter experts, instructional designers, training agencies and technical assistance facilitators to design and deliver innovative learning solutions for performance enhancements needed to support the clinical department's business objectives. Facilitates updating departmental training manuals, job aids, quick reference guides and the clinical department's policies/procedures. Develop, implement, and evaluate a preceptorship training program curriculum to standardize the quality of preceptorship practices among the clinical teams. Conducts field assessments as needed to evaluate clinical staff and update the preceptorship training program curriculum. Minimum Qualifications: Licensure: Current Registered Professional Nurse or Registered Social Worker (i.e. LMSW or LCSW) in the State of New York. Education: Bachelor's in nursing or social work preferred with previous work experience in education. Three to five years of clinical experience in a specialty area, or combination of staff nurse/leadership experience in the specialty area, i.e. Care Management, Utilization Management, Clinical Eligibility. Excellent skills in the following areas: verbal and written communication, critical thinking, creativity, interpersonal relationships and team building; change management. Demonstrates knowledge base in professional nursing or social work and evidence based practice; participatory leadership, continuous learning environment, current issues and trends in care management and clinical practice, nursing and social work education and development. Ability to travel about 10% of time around downstate New York including Westchester County and Long Island to conduct clinical observations. Preferred Qualifications: Master's degree in Education and understanding of Adult Learning Theory applications to enhance the technical assistance and education of care management and care coordination activities. Ability to assess educational needs and design and develop responsible curricula. Highly developed verbal and written communication skills and the ability to present effectively to small and large groups. Strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment. Certification in relevant clinical area and Nursing or Social Work Professional Development preferred. Intermediate Microsoft Word, Excel, Outlook and PowerPoint 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 ********************, 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 Senior Data Engineer leads and implements best-in-class data management strategies and practices through various forms of integration, data acquisition/ingestion, data cleansing/refinements, data transformations/conversions, data migrations, data purging, and back-ups. The incumbent works with a variety of users and stakeholders to understand data requirements and supports the data architecture to translate into the data management practice at Healthfirst. The Sr. Data Engineer authors artifacts defining standards and definitions for storing, processing, and moving data including associated processes and business rules. Additionally, the Sr. Data Engineer maps the details within these artifacts to business processes, non-functional characteristics, qualitative criteria, and technical enablement. He/she must constantly think through the needs of the business to support efficient and error-free processes. The Sr. Data Engineer finds trends in datasets and develops workflows and algorithms to highlight strategic raw data as useful to the enterprise. The Sr. Data Engineer creates data acquisition strategy and develops dataset processes in a robust manner according to best practices of standardization. Duties and Responsibilities: Designs and implements standardized data management procedures around data staging, data ingestion, data preparation, data provisioning, and data destruction (e.g., scripts, programs, automation, etc.) Ensures quality of technical solutions as data moves across multiple zones and environments Provides insight into the changing data environment, data processing, data storage and utilization requirements for the company, and offer suggestions for solutions Ensures managed analytic assets to support the company's strategic goals by creating and verifying data acquisition requirements and strategy Develops, constructs, tests, and maintains architectures Aligns architecture with business requirements and uses programming language and tools Identifies ways to improve data reliability, efficiency, and quality Conducts research for industry and business questions Deploys sophisticated analytics programs, machine learning, and statistical methods to efficiently implement solutions Prepares data for predictive and prescriptive modeling and find hidden patterns using data Uses data to discover tasks that can be automated Creates data monitoring capabilities for each business process and works with data consumers on updates Aligns data architecture to the solution architecture; contributes to overall solution architecture Develops patterns for standardizing the environment technology stack Helps maintain the integrity and security of company data Additional duties as assigned or required Minimum Qualifications: 8+ Years overall IT experience Enterprise experience in scripting languages primarily Python and Pyspark building enterprise frameworks Enterprise experience in data ingestion methodologies using different etl tools(Glue,DBT or any other) Enterprise experience in data warehousing concepts and big data technologies like EMR, Hadoop Enterprise experience in any cloud infrastructure like AWS,GCP,Azure Strong SQL expertise across different relational and NoSQL Databases. Preferred Qualifications: Strong knowledge of data security, encryption, and compliance standards. Hands-on experience with CI/CD pipelines and DevOps practices in a data engineering environment. Experience in API building Experience building stream platform Compliance and 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): $134,600 - $194,480 All Other Locations (within approved locations): $119,600 - $177,905 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.