Writer/Editor, Clinical Regulatory and Compliance

The Writer/Editor works within Clinical Business Management and Operations and is responsible for editing/auditing written Utilization Management (UM) adverse determination letters across all Healthfirst's managed care products, as well as Care Management (CM) Person Center Service Plan (PCSP) letters. The Writer/Editor will independently and accurately audit, edit and compose/generate a wide variety of member and provider correspondence to ensure compliance with State and Federal regulations.

Duties And Responsibilities

Conduct daily reviews of member and provider correspondence while reviewing clinical system (TruCare) events to ensure compliance with all State and Federal regulations.
Meet established time frames for completion of assigned correspondence.
Identify deficiencies and provide feedback to reduce errors and improve processes and performance to ensure quality.
Review and investigate a variety of member and provider correspondence to ensure all elements of the letter match what is in the Clinical system (TruCare) and ensure the correct template is being used appropriately.
Collaborate with care managers in UM, CM, the leadership team and peer reviewers to comply with regulatory-mandated notices.
Analyze/audit letters for appropriate medical terminology using departmental policies and federal and state regulations.
Assist with the creation, storage, protection, retrieval, and retirement of letters to enrollees, providers and facilities from company systems.
Ensure compliance with Healthfirst’s corporate branding requirements.
Additional duties as assigned.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $47,403 - $62,400
All Other Locations (within approved locations): $41,101 - $60,320

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.

The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.