Medical Peer Reviewer
Healthfirst
About this role
A Medical Peer Reviewer at Healthfirst ensures adherence to internal and external regulations by assessing medical necessity and making clinical judgments. The role involves reviewing authorization requests and claims payment based on medical records and internal information.
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
$123k – $188k
per year
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