Clinical Care Coordinator Call Center – CCM/RPM/BHI

Essen Health Care is the largest privately held, multispecialty medical group in New York, providing high-quality, compassionate care to some of the state’s most vulnerable and underserved residents.

Founded in 1999, we’ve grown from a single primary care office into a network of 50+ locations offering urgent care, primary care and specialty services, from women’s health to endocrinology and psychiatry. We also provide nursing home support, care management, and in-home care through our Essen House Calls program. Guided by a Population Health model, our team of 500+ providers deliver care in-person, at home, or via telehealth, ensuring patients get the support they need when and where they need it.

We’re looking for talented, motivated individuals to join our growing team. Whether you’re a medical provider, administrator, or operations professional, there’s a career here for you. Join us in making a real difference in the health of our community.

We are seeking a proactive and compassionate Clinical Call Center Care Coordinator to support patients enrolled in value-based care programs including Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Behavioral Health Integration (BHI). This non-clinical, call center-based role focuses on patient outreach, care coordination, and supporting clinical teams in the delivery of ongoing, structured care for patients with chronic and behavioral health conditions. 

• • Conduct scheduled outbound calls to patients enrolled in CCM, RPM, or BHI programs to support care plan adherence. 

• • Assist in collecting vitals and patient-reported outcomes related to chronic or behavioral health conditions using standardized scripts and workflows. 

• • Reinforce care plans, encourage treatment adherence, and address barriers to care (e.g., transportation, medication access). 

• • Escalate clinical concerns to licensed team members, including RNs, LCSWs, or providers as appropriate. 

• • Coordinate follow-up care, appointments, or community services based on patient needs. 

• • Accurately document patient interactions in the care management platform and ensure compliance with CMS program requirements. 

• • Collaborate with interdisciplinary care teams to support the continuity and quality of care. 

• • Bachelor’s degree in Public Health, Social Work, Health Administration, or a related field preferred. 

• • At least 1 year of experience in care coordination, case management, or patient outreach—preferably in a CCM, RPM, or BHI setting. 

• • Clinical certification such as Medical Assistant (MA), Certified Nursing Assistant (CNA), or similar credential required. 

• • Familiarity with CMS care management programs (CCM, RPM, BHI) and their documentation requirements preferred. 

• • Strong interpersonal, organizational, and communication skills. 

• • Ability to work independently in a high-volume, metrics-driven environment. 
• Bilingual a plus
•  
• Salary: $18-$21 an hour

Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.