Clinical Auditor: Appeals and Grievances
Healthfirst
About this role
A Clinical Auditor at Healthfirst evaluates clinical operations and compliance across care management, utilization management, and delegated vendors to ensure adherence to regulatory requirements and organizational quality standards. The role focuses on assessing documentation and processes to identify gaps and support performance improvement. It requires an active New York State LPN or RN license and may be based in New York City or other approved locations.
Skills
Qualifications
About Healthfirst
healthfirst.orgHealthfirst is a not‑for‑profit health insurer focused on serving New Yorkers with a range of plans including Medicaid, Medicare Advantage, Child Health Plus, the Essential Plan, and individual & family coverage across New York City, Long Island, Westchester and nearby regions. The company emphasizes coordinated, community‑focused care through a large provider network, care management programs, preventive services, and support for social needs. Healthfirst provides member tools and customer support for plan selection and access to services, and runs quality and population‑health initiatives aimed at improving outcomes and reducing disparities.
Salary
$72k – $116k
per year