Healthfirst

Technical Product Manager

• Lead delivery execution for assigned data capabilities, ensuring alignment to priorities, timelines, and quality expectations set by product and platform leadership.
• Manage and mentor a multidisciplinary team (onshore/nearshore/offshore as applicable), fostering collaboration, accountability, and continuous improvement.
• Partner with IT, architecture, and governance to implement scalable, secure, and compliant data solutions leveraging AWS services (e.g., S3, Glue, Lambda, Redshift, Athena).
• Translate business requirements into actionable features and user stories; support backlog readiness through refinement, estimation, dependency tracking, and acceptance criteria.
• Support stakeholder communication by providing clear status, risks, tradeoffs, and delivery transparency; escalate issues and decisions when needed.
• Participate in incident triage and production support for assigned data assets, helping drive root cause analysis, corrective actions, and prevention measures.
• Promote modernization and standardization by adopting reusable patterns, metadata-driven approaches, and improved pipeline reliability (including transition away from legacy tools where applicable).
• Champion data quality practices (validation, monitoring, lineage awareness, and documentation) to support regulatory reporting and analytics confidence.

Technical Product Manager, Production Support

Manager

• Provides daily oversight for Case Management teams
• Oversees utilization management functions including timely authorizations
• Develops and monitors goals for staff; provides ongoing feedback and coaching
• Collaborates with medical staff and reviews medical charts to obtain information for appropriate utilization management
• Allocate, monitor, and control resources while delegating and monitoring workloads
• Develops and analyzes operational and analytical reports to monitor operational efficiency
• Properly documents utilization management activities
• Functions as a clinical resource for the multi-disciplinary care team

Utilization Management Manager

Customer Success Manager

• Responsible for identifying, recruiting and onboarding new clients
• Support successful client implementations, ensuring clients have an excellent customer experience, adopt our tools and perform at the highest levels
• Document client business requirements and help validate that the final product solution meets business needs
• Build meaningful relationships with clients (e.g. providers, pharmacies, client data management vendors); serve as a primary point of contact for client inquiries, issues, and escalations
• Provide timely, accurate, and solutions-oriented product support; troubleshoot technical and functional issues, escalating complex matters as needed, act as a liaison between product, implementation and technical teams
• Maintain knowledge of company products and services to effectively support clients
• Identify recurring issues and recommend process or product improvements; work closely with all levels of end users to document business processes and workflows and begin identifying possible approaches to gaps, issues or risks
• Design, develop, and maintain client-facing and internal training materials (guides, presentations, job aids, FAQs)
• Deliver live and virtual training sessions to clients and internal stakeholders
• Assess training effectiveness and continuously improve learning materials and programs
• Support onboarding efforts for new clients through structured implementation and training programs
• Assist in the planning, scheduling, and facilitation of client meetings, including onboarding sessions, status updates, and training workshops
• Prepare clear agendas, presentations, and supporting documentation
• Document meeting outcomes, action items, and follow-ups
• Manage project expectations through regular client meetings, project status reports and maintaining a great relationship throughout the implementation life cycles
• Create and maintain comprehensive documentation, including SOPs, knowledge base articles, release notes, and troubleshooting guides
• Ensure documentation is clear, accurate, and accessible
• Maintain internal administrative and knowledge-based repositories to support team efficiency
• Contribute to continuous improvement of support workflows and processes

Client Success Specialist

Data Engineer

• Aligning future state enterprise information architecture with corporate strategy
• Collaborates with enterprise architects and solution architects
• Supports enterprise data architecture roadmap by managing architectural runway
• Provides data architecture thought leadership
• Establishes collaborative, cross-functional relationships

Enterprise Data Architect

• The Data Engineer is responsible for data acquisition strategies and integration, scripting and tools, data migrations, conversions, purging, and back-ups.
• The incumbent works with product, financial control, analysts, users, and other stakeholders to understand business requirements and support data architecture to build data acquisition strategies.
• The Data Engineer authors artifacts defining standards and definitions for storing, processing, and moving data including associated processes and business rules.
• Additionally, the Data Engineer maps the details within these their artifacts to business processes, non-functional characteristics, QA criteria and technical enablement.
• He/she constantly thinks through the needs of the business to support efficient and error-free processes.
• Finds trends in datasets and develops workflows and algorithms to make raw data useful to the enterprise.
• Designs and implements standardized data management procedures around data staging, data ingestion, data preparation, data provisioning, and data destruction (scripts, programs, automation, assisted by automation, etc.).
• Ensures quality of technical solutions as data moves across Healthfirst 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 support Healthfirst’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.
• Prepares data for predictive and prescriptive modeling and finds 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 Healthfirst solution architecture; contributes to overall solution architecture.
• Helps maintain the integrity and security of the company data.

Pharmacist

• Review medication lists to eliminate barriers to therapy
• Contact pharmacies for medication refills
• Document care and communicate with providers
• Facilitate access to medications for financially challenged members

Clinical Pharmacy Technician

Executive Assistant

• Supports the Chief Legal Officer/General Counsel and provides administrative help to the Legal Department.
• Responsible for handling complex and confidential information daily.
• Answers requests for legal documents and maintains departmental files.
• Coordinates meetings & maintains managers' schedules.
• Preparation of Board books and may take minutes as needed.
• Controls operational aspects of the department including routing the daily mail and office supplies.
• Documents proofreading, drafting, and editing in various software mediums.

Executive Assistant, Legal

Accountant

• Preparing monthly journal entries for all Revenue and Expenses.
• Ensuring efficient external support for the journal entries.
• Analyzing and providing explanations for P&L monthly.
• Reconcile accounts monthly and work with stakeholders within Finance.
• Compile data to identify and reconcile variances in a timely matter.
• Reconcile general ledger data to EMR data monthly.
• Create monthly analysis for respective LOB to summarize general ledger activity.

Staff Accountant

• Support initiatives to resolve gaps in care through direct provider and member outreach
• 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
• 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

Clinical Pharmacist, MTM

Account Manager

• Develops and maintains an Ancillary provider network
• Ensures Healthfirst members have access to the highest quality care
• Works with multiple provider types e.g. physician, ancillary, medical groups
• Manage a network of Ancillary Providers for all lines of Healthfirst's business
• Monitor and audit contracted ancillary providers
• Create contracts in HF contract software
• Negotiate and execute Single Patient Agreements for Out Of Network (OON) Providers
• Educate newly credentialed Providers on Healthfirst's policies and procedures
• Analyze provider network based on monthly reports
• Identify root cause of claims issues and facilitate resolution

Ancillary Services Network Account Manager I

Human Resources

• Define and own end-to-end HR system integration architecture
• Design and document data flows, integration patterns, and system dependencies
• Partner with IT to design and implement APIs and system-to-system connections
• Identify and correct configuration issues that drive manual work, errors, or confusion
• Ensure HR systems function as a cohesive ecosystem rather than siloed tools
• Establish monitoring, alerting, and health tracking for key integrations
• Perform root cause analysis and implement permanent fixes
• Define and enforce HR data standards
• Identify system and integration issues that drive unnecessary HR demand
• Serve as primary technical liaison across HR vendors, IT, and internal stakeholders
• Establish and maintain documentation of system integrations and data flows

Senior Manager, HR Technology, Integration

Customer Support

• Conduct outreaches for newly enrolled members to review current and approved services, durable medical equipment (DME) and additional requests
• Review intake documents for pre-approved services and escalate discrepancies as needed
• Complete Welcome Onboarding and Consumer Directed Personal Assistant Assessments and identify any issues or risk factors that require clinical escalations to a CM/PCM.
• Initiate and finalize authorization in Trucare for preapproved services and DMEs and update and discontinue authorizations when applicable
• Handle and accurately document calls to and from members to assist with benefit questions/issues, schedule appointments, assessment inquiries, service issues and grievances
• Handle and accurately document calls to and from providers regarding authorizations initiation/updates, referrals, visits, tests, and faxed care plans
• Provide education to members and providers regarding requirements for approval of service requests
• Manage a large caseload while communicating member issues or needs and monitoring screening of members effectively to improve quality and cost outcomes
• Communicate with Inter/Intra-departments regarding reconciling onboarding issues
• Additional duties as assigned.

Support Specialist

• Review prior authorization requests for medications
• Develop clinical criteria and medical policies for medications
• Conduct prior authorization reviews in compliance with CMS and NYSDOH guidelines
• Research drug information and maintain drug knowledge for reviews
• Review monthly reports and provide feedback on trends and efficiency

Clinical Pharmacist

Bilingual

• The Service Agent is responsible for supporting Contact Center Operations (CCO) by ensuring members and/or providers receive an exceptional customer experience.
• This individual receives and addresses member & provider inquiries, resolves complaints, educates clients, retains members, helps to prevent dis-enrollments, and escalates issues requiring additional intervention across all Lines of Business (LOBs).
• Provides excellent quality customer service to our members and/or providers relating to all aspects of member/provider questions and issues.
• May include but is not limited to inbound/outbound calls/emails/chats, onsite/remote/virtual/field location, on behalf of CCO.
• Meets/Exceeds all performance KPIs including but not limited to quality, productivity, and dependability.
• Follows established policies and procedures to ensure member and provider issues are addressed timely and accurately.
• Identifies and de-escalate situations where member/provider is upset and provides resolution for their issue.
• Initiates investigations as required, partnering with other assigned parties to participate in root cause analysis.
• Complies with HIPAA requirements and maintains Protected Health Information (PHI) confidentiality.
• Builds sustainable relationships of trust through open and interactive communication with internal and external customers.
• Works a flexible schedule including a late shift, weekends, and/or holidays (with limited notice at times), and as needed during unforeseen business disruptions.
• Additional duties as required.

CCO Service Agent, Bilingual

Sales

• Responsible for coordinating events, presentations and enrollment opportunities, as directed by the Sales Managers, in order to execute, plan, and coordinate resources so that they can ensure a successful event
• Sales Support Associates are responsible for positioning Healthfirst as a socially responsible health partner
• Will develop and coordinate a comprehensive strategy that promotes company-wide enrollment through promotions, events, sponsorships and collaboration with like-minded partners
• The representative will work closely with Medicare Sales Managers and representatives to increase awareness, knowledge of Healthfirst’s products and services, and to also increase Healthfirst’s market-share in the territory
• Identify enrollment events opportunities for seniors--individually or in groups--to promote alternative plan options
• Through community marketing she/he will have a direct impact on membership growth and retention
• Using innovative and strategic growth plans developed in collaboration with the sales team, the Sales Support Associate will have the ability to join a team dedicated to helping some of the most vulnerable populations in New York