Overview

Our client is a high growth, entrepreneurial, home-based provider team that is transforming healthcare by serving the extensive needs of the most chronically ill in our communities. Physicians lead a multidisciplinary team and serve on the frontlines delivering preventive and urgent medical care in the homes of complex, frail, and vulnerable patients.

Through the integration of technology, a highly innovative care delivery model, and multidisciplinary clinical teams, our client delivers health management capabilities at scale for the frailest and most clinically complex segments of the population – the 3-5% of members that account for 20-30% of all national healthcare expenses annually.

Responsibilities

As a Physician, your duties will be to:

• Function as day-to-day clinical leader, providing decision support to nurse practitioners and directing the multidisciplinary team
• Perform 4-6 preventive visits daily to optimize chronic conditions, assess home environment, educate patients and caregivers, and develop proactive care plans
• Perform urgent care visits in the home to avoid unnecessary ED transfers and hospital admissions
• Leverage the support of nurse care manager, behavioral health, social work, pharmacy, and dietician to meet patients’ medical, biopsychosocial, and financial needs
• In situations where there is no existing PCP for the patient, assume responsibility as PCP to drive care and continuity for patients
• In situations where there is an existing PCP for the patient, help to co-manage the patient with the PCP and serve as an extension of clinical care into the home
• Coordinate with other physicians across the continuum of care, including PCP, hospitalist, and SNF providers to smooth transitions and prevent readmissions
• Coordinate and offer medical direction to community-based organizations touching the lives of our patients, including housing and caregiver agencies, health plan contracted social work services, home health, adult day health centers, and behavioral health

Qualifications

• Board Certified / Board Eligible Physician, preferably Internal Medicine, Family Medicine, or Emergency Medicine
• Doctor of Medicine M.D. or Doctor of Ostepathy D.O. from an accredited educational institution
• DEA registration
• Experience managing complex, polychronic patients and comfort with high acuity
• Dedication to transforming care for the sickest and frailest in a marginalized population
• Access to reliable transportation to conduct patient visits required; if you are driving a vehicle, you must comply with all the terms of the our Motor Vehicle Safety policy.
• Eagerness to work with a diverse and multidisciplinary team.
• Must be board certified at the time of hire or able to obtain board certification during the eligible timeframe (5 years following completion of residency or other training)