Physician, Complex Chronic Care
Practice Your Passion
The most medically vulnerable patients’ needs are hard to address in today’s fee-for-service system. Care is fragmented and in time-limited slots.
Complex and frail patients living with multiple co-morbidities benefit from additional care that comes to them. Care that is coordinated with their existing doctors and specialists.
Our physician-led teams specialize in house calls to bring medical care to patients where they reside and when they need it. Our multidisciplinary model includes physicians, nurse practitioners, physician assistants, social workers, dietitians, behavioral health specialists, social workers, nurse care managers and care coordinators.
See the whole picture and treat the whole patient by bringing advanced medical care to patients in their homes.
- 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 dietitian to meet patients' medical, biopsychosocial, and financial need
- 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
- Board Certified / Board Eligible Physician, preferably Internal Medicine, Family Medicine, or Emergency Medicine
- Doctor of Medicine M.D. or Doctor of Osteopathy D.O. from an accredited educational institution
- DEA registration
Posted April 14, 2021