Overview

At Essen Health Care, we care for that. Essen Health Care is the largest privately held multispecialty medical group in the Bronx, delivering high-quality, compassionate, and accessible care to some of the most vulnerable and underserved communities in New York State. Guided by a population health model, Essen operates six integrated clinical divisions providing house calls, medical services, urgent care, primary care, specialty services, nursing home staffing, and comprehensive care management programs.

Intention Healthcare is the house calls division of Essen Health Care, delivering primary and specialty services directly to patients in their homes. The population served is medically complex and frequently homebound, with chronic disease commonly co-occurring with behavioral health conditions, housing instability, food insecurity, and limited social support. The division currently operates in New York, New Jersey, Massachusetts, and Ohio, and continues to expand into additional markets.

Job Summary

The General Manager, Integrated Care Management, is responsible for the operational leadership, performance management, and scalable execution of Intention Healthcare's integrated care management model, designed to keep some of the most vulnerable patients in our care stable, supported, and out of the hospital.

The role oversees a team of Care Management and RPM Supervisors, each responsible for a set of provider pods and the Integrated Care Coordinators supporting their attributed patient panels. The General Manager is accountable for ensuring that supervisors, coordinators, provider pods, and centralized support teams operate against a common set of expectations for patient engagement, clinical follow-through, documentation compliance, billing readiness, productivity, and provider satisfaction, and for building an operation where every layer of that structure is working, ultimately, on behalf of the patient at the center of it.

This position translates organizational strategy into consistent daily execution across a multi-program, panel-based care model. This is a fully in-person role.

The Integrated Care Management

Care management works when a patient has one consistent point of contact, someone who knows their history, coordinates what needs to happen next, and follows through until it does. For patients managing chronic illness at home, that continuity is often what allows a medication issue to be caught before it becomes an admission, or a housing crisis to be resolved before it becomes a hospitalization. Every program, workflow, and system in this model exists to support that relationship.

Intention Healthcare's care management model is built on continuity of relationship. Each patient is assigned to a single Integrated Care Coordinator who is accountable for that patient across every program for which they are eligible, rather than assigning patients to separate coordinators by program. This structure is intended to reduce duplicative outreach, consolidate accountability, and allow the coordinator to develop sufficient familiarity with the patient to identify clinical deterioration and unmet need early.

The coordinator serves as the patient's operational point of contact across the care continuum: conducting structured monthly assessments, coordinating appointments and referrals, monitoring medication adherence and remote monitoring data, addressing social determinants of health, and escalating clinical concerns to the treating provider.

Care management activity is funded through Chronic Care Management, Advanced Primary Care Management, Principal Illness Navigation, Community Health Integration, Behavioral Health Integration, Remote Patient Monitoring, and the New York State Health Home program. Each carries distinct eligibility, service, documentation, and billing requirements, and this role is accountable for compliant execution across all of them.

Responsibilities

1. Integrated Care Model Leadership
   • Lead day-to-day operations of the integrated care model across all care management programs.
   • Ensure supervisors execute consistently across assigned provider pods and patient panels.
   • Ensure coordinator worklists are prioritized by clinical risk and unmet need rather than ease of completion.
   • Translate organizational goals into clear, measurable operational targets for supervisors and coordinators.
   • Build scalable workflows that support growth in enrollment, billing capture, patient engagement, and quality performance.
   • Identify operational risks, workflow gaps, and execution barriers that may affect patient care, compliance, or revenue.
2. Supervisor Oversight and Performance Management
   • Directly oversee Care Management and RPM Supervisors responsible for provider pods and coordinator teams.
   • Set clear expectations for supervisor performance, including panel health, enrollment growth, productivity management, documentation quality, provider responsiveness, escalation closure, and staff accountability.
   • Review supervisor dashboards and pod-level performance trends on a daily, weekly, and monthly basis.
   • Coach supervisors on workload management, real-time intervention, staff performance, escalation handling, and provider communication.
   • Conduct regular performance reviews and implement corrective action plans when operational targets are not met.
   • Develop supervisors into operational leaders capable of managing larger panels and more complex workflows.
3. Panel Performance and Enrollment Growth
   • Own performance across assigned patient panels, provider pods, and care management programs.
   • Drive enrollment growth among eligible patients and ensure enrollment converts to sustained patient engagement.
   • Monitor panel penetration rates, outreach outcomes, consent capture, activation rates, and ongoing program participation.
   • Partner with providers and clinical leadership to increase adoption of care management programs.
   • Use data to identify underperforming pods, missed enrollment opportunities, and disengaged patients.
4. Productivity, Billing Readiness, and Compliance
   • Ensure Integrated Care Coordinators meet program-specific productivity, documentation, and time threshold requirements.
   • Monitor completion rates, monthly activity capture, billing readiness, and documentation quality across all programs.
   • Ensure workflows comply with CMS requirements, New York State Medicaid and Health Home standards, payer rules, internal documentation standards, and audit readiness expectations.
   • Partner with Revenue Cycle, Compliance, Analytics, and Product teams to improve billing capture and reduce preventable denials.
   • Identify margin pressure resulting from low productivity, missed billing opportunities, documentation deficiencies, or inefficient staffing models.
   • Establish accountability systems that ensure performance gaps are addressed promptly and consistently.
5. Provider Pod Operations and Relationship Management
   • Ensure supervisors serve as effective operational liaisons to assigned providers.
   • Monitor provider satisfaction, responsiveness, workflow escalations, and unresolved operational issues.
   • Standardize communication among supervisors, providers, coordinators, and centralized support teams.
   • Resolve escalated provider concerns related to care management workflows, RPM, referrals, DME, lab and imaging follow-up, patient outreach, and panel support.
   • Maintain a provider-facing operating model that reduces confusion, improves response time, and strengthens accountability.
6. Cross-Functional Coordination
   • Partner with centralized Lab/DI, Referral, DME, RPM, Scheduling, Clinical, Revenue Cycle, Product, Analytics, and Compliance teams.
   • Escalate systemic barriers affecting pod performance, patient care, billing readiness, or provider experience.
   • Support cross-departmental workflow redesign to improve turnaround time and reduce duplication.
   • Ensure operational handoffs are clearly defined among provider pods, supervisors, coordinators, and centralized teams.
7. Workforce Planning and Scalability
   • Evaluate staffing ratios, supervisor span of control, coordinator productivity, and panel volume.
   • Recommend staffing models that support enrollment growth, geographic expansion, and multi-program execution without compromising continuity of the coordinator-patient relationship.
   • Support hiring, onboarding, training, and development of supervisors and Integrated Care Coordinators.
   • Identify automation opportunities that reduce manual work, improve productivity, and increase billing capture.
8. Data, Dashboards, and Executive Reporting
   • Use operational dashboards to monitor pod performance, supervisor effectiveness, staff productivity, enrollment trends, billing readiness, and quality outcomes.
   • Prepare clear performance summaries for senior leadership.
   • Track key metrics including enrollment volume, active caseload, outreach completion, consent capture, monthly activity completion, RPM adherence, billing eligibility, documentation quality, provider satisfaction, and staff productivity.
   • Provide data-driven recommendations to improve margin, scale, compliance, and operational execution.

Qualifications

Education

Bachelor's degree in healthcare administration, business administration, public health, nursing, social work, operations management, or a related field required. Master's degree preferred (MHA, MBA, MPH, or MSW).

Experience

Minimum 5–7 years of experience in healthcare operations, population health, care management, remote patient monitoring, value-based care, or clinical operations. Minimum 2–3 years of supervisory or management experience required; experience managing supervisors, team leads, or multi-team operational structures strongly preferred. New York State Health Home experience strongly preferred, including work within a Care Management Agency and working knowledge of core services, the Billing Support Questionnaire and rate code structure, MAPP/HHTS, DOH-5055 consent requirements, the CES Tool, diligent search protocol, and Medicaid recertification workflows. Social work background strongly preferred, including LMSW or LCSW licensure or substantive experience in case management, behavioral health, or community-based services. Direct caseload experience is valued. Experience with CMS care management programs, including CCM, APCM, PIN, CHI, BHI, and RPM, strongly preferred. Experience in provider-facing operations, panel management, home-based care, or multi-site healthcare operations preferred.

Technical Skills

Proficiency in EMR systems (eClinicalWorks preferred). Experience with care management platforms such as Foothold/FCM, BAHN, or equivalent. Proficiency with productivity dashboards and performance tracking tools. Strong working knowledge of CMS care management program requirements and New York State Medicaid Health Home standards.

Core Competencies

Operational leadership and accountability, Multi-team performance management, Supervisor coaching and staff development, Data-driven decision-making, Provider relationship management, Population health and care management operations, Billing readiness and compliance oversight, Workflow redesign and process improvement, Cross-functional execution, Escalation management and problem-solving, Scalable workforce planning, Executive communication.

Work Location

On-site, fully in-person at Bronx, NY, office location

Compensation

$90,000-$120,000 with performance bonus

Equal Opportunity Employer

ESSEN HEALTH CARE IS PROUD TO BE AN 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.