Primary Care; 250-300 panel size - Baltimore
Care Beyond Medicine
AbsoluteCare is designed to care for society's most chronic complex community based patients. An AbsoluteCare provider puts the principles of team-based care and population health management into action for our medically complex and socially vulnerable members. Our providers have experience treating patients with multiple chronic diseases and truly believe in the value of a team-oriented Patient Centered Medical Home (PCMH) model.
- Treat some acute exacerbation of chronic conditions onsite, utilizing the ambulatory care infusion center. Possess a comfort level and the knowledge to differentiate when exacerbation can be treated within AbsoluteCARE and when a higher level of care needed.
- Manage and improve health for patients with multiple chronic medical conditions. Track patients and their disease processes to prevent ER visits, hospital admissions, and readmissions.
- Work in a team environment, process feedback, and facilitate discussion. Implement plans of care from other team members.
- Develop strong transitional care plans to track paneled patients along the continuum of care.
- Accept same day/next day or urgent appointments for patients from home or discharged from the hospital/ER/skilled nursing facility in need of intensified physician or case management/social work services.
- Educate patients regarding their chronic diseases and healthy choices.
- Practice evidenced based medicine in accordance with the PCMH model.
- Track and achieve specified quality metric goals.
- Active Maryland medical license
- Internal Medicine or Family Medicine BC
- BLS certification
- Success working as part of a multidisciplinary team; excellent interpersonal communication skills
- Problem resolution
- Understanding PCMH model of care as it pertains to specialist care
- Population health management; NCQA PCMH model
- Psycho-socially and medically complex patients
- Success maximizing EMR systems
Posted June 15, 2021