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Healthfirst

Healthfirst is a not-for-profit health insurer based in New York, dedicated to providing no-and low-cost health insurance options to residents in New York City and surrounding areas. With a focus on prioritizing health outcomes over profits, Healthfirst serves nearly two million members through a partnership model with local hospitals and health systems. The organization offers a variety of health plans, including Medicaid, Medicare Advantage, and Child Health Plus, ensuring access to quality healthcare for all New Yorkers.

<div>Position Summary: The Appeals &amp; Grievances Clinical Specialist is responsible for receiving, investigating and responding verbally and in writing to member and provider clinical appeals and grievances.
Duties and Responsibilities:<ul><li>
Ensures that appeals and grievances are properly classified (e.g. denial of service, denial of payment, or a grievance about a provider)</li><li>
Processes appeals and grievances in accordance with internal company policy</li><li>
Enters data into appropriate medical management services</li><li>
Collaborates with other departments to thoroughly investigate appeal and grievances.</li><li>
Prepares for and participates in regulatory site visits.</li><li>
Additional duties as assigned.</li></ul>
Minimum Qualifications:<ul><li>
LPN or RN
Preferred Qualifications:</li></ul><ul><li>
Experience in clinical practice with experience in appeals &amp; grievances, claims processing, utilization review or utilization management/case management.</li><li>
Understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual or Medicare Guidelines.</li><li>
Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as corporate email and virtual filing system. (ie. Macess).</li><li>
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment</li></ul> 
Hiring Range*:<ul><li>
Greater New York City Area (NY, NJ, CT residents): $83,100 - $120,360</li><li>
All Other Locations (within approved locations): $73,400 - $108,160</li></ul>

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.
<ul><li>The hiring range is defined as the lowest and highest salaries that Healthfirst in &ldquo;good faith&rdquo; would pay to a new hire, or for a job promotion, or transfer into this role.</li></ul> 
73400-108160</div>

A&G Clinical Specialist

<div>The Manager, Production Support supports the delivery of Healthfirst&rsquo;s data platforms and solutions by leading day-to-day execution for a defined set of data products, pipelines, or platform capabilities. This role partners with product owners, architects, governance, and business stakeholders to translate requirements into high-quality, secure, and scalable data assets that enable analytics, regulatory reporting, and business operations. The Manager leads an Agile delivery team (analysts, developers, testers, and/or scrum master support), ensuring reliable delivery, strong operational discipline, and continuous improvement across planning, build, testing, release, and production support.
Key Responsibilities<ul><li>
Lead delivery execution for assigned data capabilities, ensuring alignment to priorities, timelines, and quality expectations set by product and platform leadership.</li><li>
Manage and mentor a multidisciplinary team (onshore/nearshore/offshore as applicable), fostering collaboration, accountability, and continuous improvement.</li><li>
Partner with IT, architecture, and governance to implement scalable, secure, and compliant data solutions leveraging AWS services (e.g., S3, Glue, Lambda, Redshift, Athena).</li><li>
Translate business requirements into actionable features and user stories; support backlog readiness through refinement, estimation, dependency tracking, and acceptance criteria.</li><li>
Support stakeholder communication by providing clear status, risks, tradeoffs, and delivery transparency; escalate issues and decisions when needed.</li><li>
Participate in incident triage and production support for assigned data assets, helping drive root cause analysis, corrective actions, and prevention measures.</li><li>
Promote modernization and standardization by adopting reusable patterns, metadata-driven approaches, and improved pipeline reliability (including transition away from legacy tools where applicable).</li><li>
Champion data quality practices (validation, monitoring, lineage awareness, and documentation) to support regulatory reporting and analytics confidence.</li></ul>
Minimum Qualifications<ul><li>
Bachelor&rsquo;s degree in Computer Science, Information Systems, Engineering, or related field (or equivalent experience).</li><li>
5+ years of experience in data engineering, systems analysis, BI/data platforms, or technical delivery roles supporting large-scale data environments.</li><li>
2+ years of experience leading or coordinating Agile delivery (team lead, delivery lead, scrum/iteration leadership, or engineering management).</li><li>
Working knowledge of AWS data services (e.g., S3, Glue, Lambda, Redshift, Athena) and modern ETL/ELT concepts.</li><li>
Strong SQL and data troubleshooting skills with the ability to validate logic, investigate defects, and support data integrity.</li><li>
Strong communication skills and ability to work across technical and business partners to clarify needs and deliver outcomes.</li></ul>
Preferred Qualifications<ul><li>
Experience in healthcare insurance, provider, claims, or regulatory reporting data domains.</li><li>
Experience supporting cloud migration and data modernization initiatives (including decommissioning or reducing dependency on legacy ETL tools).</li><li>
Certifications such as CSM, PMP, or AWS (nice to have).</li></ul>
Compliance and Regulatory Responsibilities: N/A
License/Certification: N/A 
Hiring Range*:<ul><li>
Greater New York City Area (NY, NJ, CT residents): $134,600 - $194,480</li><li>
All Other Locations (within approved locations): $119,600 - $177,905</li></ul>

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.
<ul><li>The hiring range is defined as the lowest and highest salaries that Healthfirst in &ldquo;good faith&rdquo; would pay to a new hire, or for a job promotion, or transfer into this role.</li></ul> 
119600-177905</div>

Technical Product Manager, Production Support

Join Healthfirst and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Healthfirst

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A&G Clinical Specialist

Technical Product Manager, Production Support