Integrated Care CoordinatorEssen Health Care's Care Management Division is seeking an Integrated Care Coordinator (ICC) to provide comprehensive care coordination services to patients with complex chronic conditions, including those enrolled in the New York State Health Home program.The ICC is a core member of Essen's care management team, responsible for ensuring that high-need patients receive coordinated, whole-person care across medical, behavioral health, and social service systems. As Essen continues to expand its Care Management Division, ICCs may support additional evidence-based care management programs within the division, consistent with their qualifications and the needs of the organization.ResponsibilitiesHealth Home — Complex Care Management (Primary)Manage an active caseload of patients enrolled in the New York State Health Home program, with a focus on homebound and medically complex individualsConduct comprehensive assessments and develop individualized care plans that address medical, behavioral health, housing, and social determinants of healthProvide regular outreach, monitoring, and follow-up to ensure care plan implementation and patient engagementCoordinate across primary care, specialty care, behavioral health providers, and community-based organizations to close gaps in careMaintain timely, accurate documentation in compliance with NYSDOH Health Home program standardsParticipate in care team meetings, case conferences, and quality improvement activitiesSupport patients in navigating insurance, benefits, and community resourcesCare Management Program Support (As Assigned)Consistent with the Care Management Division's integrated model, ICCs may also be assigned to support patients in additional care management programs offered through Essen Health Care. These assignments are made based on the coordinator's qualifications, experience, and program need, and include activities such as:Chronic disease monitoring and patient engagement under Medicare and Medicaid care management programsPreventive care outreach and care gap closure for primary care patient populationsCare transition support, including scheduling coordination and documentation for patients moving between care settingsPatient enrollment and onboarding for care management program participantsQualificationsRequiredBachelor's degree in Social Work, Nursing, Public Health, Health Education, or a related field — or equivalent professional experienceMinimum 1–2 years of experience in care management, case management, or healthcare coordinationKnowledge of the New York State Health Home program, Medicaid managed care, or community-based care servicesStrong patient communication skills with demonstrated ability to engage medically complex or vulnerable populationsAbility to manage a patient caseload with organized documentation and consistent follow-throughProficiency with electronic health records (EHR) and care management platformsPreferredActive clinical or care management credential: LMSW, RN, LPN, CHW, or equivalentExperience with chronic disease management, behavioral health integration, or homebound patient populationsBilingual in Spanish, Mandarin, Cantonese, or another language serving Essen's patient communitiesFamiliarity with Medicare and Medicaid care management programs including CCM, BHI, RPM, or APCMBackground in patient outreach, enrollment, or community health workCompensation & BenefitsPay: $20.00 - $25.00 per hourJob Type: Full-timeRemote & Hybrid opportunities available (Subject to change)Equal Opportunity EmployerEssen 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.