Clinical Call Center Care Coordinator – CCM/RPM/BHI

Overview

At Essen Health Care, we care for that! 

As the largest privately held multispecialty medical group in the Bronx, we provide high-quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management. Founded in 1999, our over 20-year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system. Essen has expanded from a single primary care office to an umbrella organization offering specialties from women’s health to endocrinology, from psychiatry to a vast array of other specialties. All clinical services are offered via telehealth or in-person at over 35 medical offices and at home through the Essen House Calls program. 

Essen Health Care is the place Where Care Comes Together! We are looking for the most talented and effective individuals to join our rapidly growing company. With over 1,100 employees and 400+ Practitioners, we care for over 250,000 patients annually in New York City and beyond. From medical providers to administration & operational staff, there is a career here for you. Join our team today!

Job Summary

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. 

Responsibilities

• • 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. 

Qualifications

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

• • 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

Equal Opportunity Employer

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.