Aco Coordinator Jobs (NOW HIRING)

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 services, and in-home medical services through our House Calls Division, Intention Health Care and facilitate smooth transitions between care settings including telehealth, in-person medical visits, and home care through Intention Health Care. 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.

Join our ACO REACH High Needs team at Intention Essen House Calls as a Nurse Practitioner or Physician Assistant and play a pivotal role in transforming how healthcare is delivered to some of the most complex, high-risk patients in New York. This is more than primary care—it’s mission-driven, in-home care that combines clinical excellence with innovation in value-based care. You’ll work at the forefront of care delivery, developing personalized treatment plans, preventing avoidable hospitalizations, and collaborating with an interdisciplinary team to improve health outcomes and equity. As part of our ACO, you’ll not only care for patients but also help shape a new model of healthcare designed around quality, compassion, and impact.

• Provide comprehensive primary care to homebound and high-needs patients attributed to our ACO REACH program.

• Perform physical exams, record detailed medical histories, and develop evidence-based care plans tailored to patients’ clinical and social needs.

• Diagnose and treat a wide variety of conditions in general practice, with emphasis on chronic disease management and preventive care.

• Collect, record, and maintain accurate patient data in alignment with ACO documentation, coding, and quality reporting requirements.

• Order and interpret diagnostic tests, labs, and imaging studies to inform patient care plans.

• Prescribe and administer appropriate treatments and interventions, including vaccinations and medications.

• Counsel patients and caregivers on disease prevention, nutrition, lifestyle, and adherence to care plans.

• Collaborate with interdisciplinary team members—including clinical associates, nurses, and specialists—to support whole-person, coordinated care.

• Work closely with acute care, paramedicine, and hospital-at-home partners to proactively manage acute conditions and prevent unnecessary hospital admissions.

• Manage pressure ulcers, wounds, Foley and suprapubic catheters, and provide phlebotomy/IV access as needed.

• Participate in regular case conferences and patient panel reviews with the ACO team (typically every 3–4 weeks onsite in the Bronx).

• Provide timely, accurate charting and coding that reflects clinical care and ACO program standards.

• Share in after-hours coverage of the ACO emergency hotline on a rotating schedule.

• Ability to work closely and train under PCP's and other specialists to gain additional experience and knowledge

• Collaboration with dedicated care managers and a Health Home program to assit patients with Social Determinants of Health and to provide social support.

Qualifications

• Graduate of an accredited NP or PA program.

• Current New York State license and National Board Certification.

• Active DEA license.

• Minimum 3 years of clinical experience, preferably including home-based primary care, geriatrics, or complex chronic care management.

• Experience with value-based care models (e.g., ACOs, risk-bearing entities, or Medicare programs) strongly preferred.

• Familiarity with care coordination and quality reporting in ACO or similar programs.

• EMR/EHR proficiency required.

• Bilingual (Spanish) strongly preferred.

• Demonstrated ability to work independently in the home setting while collaborating with a multidisciplinary team.

Salary and Benefits:

Total compensation of $220,000(Base Salary $145,00 with potential performance incentive of $75,000)

Retention bonus after 1-year anniversary of $10,000

Medical, Dental, 401k, FSA, Life insurance and Disability, Malpractice, PTO 4 weeks after 1 year

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.