Integrated Care Navigator for Bronx Health Outreach

Essen Healthcare; New York (NY); On-site; USD 30,000 - 34,000; Full time

Benefits offered by this job

Competitive pay

Full-time role

Job summary

Essen Health Care in New York is seeking an Integrated Care Coordinator for the Intention Healthcare program. The role links patients to primary, specialty, and behavioral health services, coordinating across care settings to improve outcomes for underserved communities in the Bronx.

Responsibilities include developing care plans, managing transitions between telehealth, in-person visits, and home care, and engaging patients with English and Spanish outreach to navigate community resources in

Qualifications

• 1-2 years of direct patient care experience
• Experience in Care Coordination or Case Management
• Experience with Remote Patient Monitoring
• Familiarity with Electronic Health Records (EHR)
• Previous experience in outreach, community engagement, social services, or related field

Responsibilities

• Develop and maintain comprehensive care plans addressing medical, behavioral, and social determinants of health
• Coordinate services across Essen's integrated clinical divisions including urgent care, primary care, and specialty services
• Facilitate smooth transitions between care settings including telehealth, in-person visits, and home care through Essen House Calls
• Utilize Remote Patient Monitoring tools to track patient progress and proactively address health concerns
• Monitor patient adherence to care plans and adjust interventions based on outcomes
• Scheduling and coordination: book appointments for established Intention patients with physicians, specialists, and other healthcare providers in HouseCall Smart Scheduling Tool and/or CW
• Outbound calls to HC patients to schedule, remind, and follow-up on appointments
• Data management – collect and verify patient demographics, insurance information, and medical history, update records in EHR
• Insurance verification – confirm coverage and manage pre-authorizations and copays
• Administrative duties – clerical tasks like faxing, filing, and maintaining a clean workspace
• Bilingual outreach and education in English and Spanish

Skills

Bilingual: Spanish & English

Care Coordination

Remote Patient Monitoring

EHR familiarity

Travel to Bronx

Education

Bachelor's degree preferred

Tools

HouseCall Smart Scheduling Tool

CW scheduling tool

EHR system

Job description

Essen Health Care in New York is seeking an Integrated Care Coordinator for the Intention Healthcare program. The role links patients to primary, specialty, and behavioral health services, coordinating across care settings to improve outcomes for underserved communities in the Bronx.

Responsibilities include developing care plans, managing transitions between telehealth, in-person visits, and home care, and engaging patients with English and Spanish outreach to navigate community resources in