Healthfirst is a provider-sponsored health insurance company that serves 1.8 million members in downstate New York. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals. For more information on Healthfirst, visit www.healthfirst.org

Aug 28, 2022
Physician
Healthfirst Remote
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. The Medical Peer Reviewer schedule requires 5 hours a day Monday - Friday. The peak hours of the business are 10:00 a.m. -5:00 p.m. and the Medical Peer Reviewer is required to work his/her 5 hours during the core hours to perform the duties and responsibilities of the position. The role has some flexibility within the prescribed time frame. At least one weekend a month is required. If this is the case, the Medical Peer Reviewer will be off in the immediate week after. (Example: If a Medical Peer Reviewer works a total of 10 hours over the weekend, he/she will have day(s) off in the immediate days following.) Duties/Responsibilities: • The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records and...