EXPECTED OUTCOME: Under the direction of the Medical Director and in accordance with established department policies, procedures, care protocols, and provider orders, this position will work within the Patient Centered Medical Home model to systematically analyze patient health information to identify and coordinate the care needs of the individual patient focusing on the continuity of care. This position is responsible for oversight to manage and track coordination of pro-active care for patients with chronic conditions as well as identify wellness and/or preventative service for clinical patients.
JOB RESPONSIBILITIES: Clinical Care Utilizes appropriate and effective patient care plans which includes adequate diagnostic procedures therapies use of consultation and referrals outcomes Manages patients to assure continuity of care which includes adequate scheduling and tracking of return visits completion of treatment plans follow-up of chronic problems follow-up of abnormal tests follow-up of “no-show” appointments Provides whole-person care which includes appropriate referrals to the social worker and/or nutritionist referrals to mental health professionals integration of biologic, social, psychological and environmental issues Utilizes cost-containment measures which include prescribing only necessary medications prescribing generic medications when appropriate making only necessary referrals ordering only necessary diagnostic procedures utilizing the least expensive alternative resources when appropriate Maintains adequate, concise, and legible documentation of patient care which includes: problem record medication record drug allergies subjective and objective data assessment diagnostic procedures treatment patient education Provides and documents appropriate periodic health examinations which include but are not limited to: baseline and interval physical exams preschool vision exams serum cholesterol stool blood pap smears mammograms hemoglobin immunizations developmental assessments functional assessments risk assessments Provides appropriate patient education which includes: explaining the diagnosis, treatment and prognosis explaining the use and side effect of medications instructing patients about preventive dental care using patient education handouts making referrals to health education classes Focuses on satisfaction of patient and other customers which includes: Meeting the needs and expectations of patients and other customers, including co-workers Treating patients and other customers, including co-workers, in a caring and respective manner Demonstrates appropriate work habits which include: Arriving on time for Clinic sessions Returning phone calls the same day during regular hours Returning phone calls within one hour after Clinic hours Utilizing appropriate infection control measures, including universal precautions Dictating and/or writing progress notes in a timely manner Maintaining appropriate patient confidentiality Calling the HCHC if more than fifteen minutes late for clinical sessions Making scheduling changes on patient schedule only through the Medical Director Assures available and accessible patient care which includes: Providing clinical care at HealthLinc as assigned by the Medical Director Working assigned Clinic sessions – including one evening session per week Working Saturday or Sunday clinical sessions, if assigned and as reasonably agreed upon between Doctor and Corporation Working an additional evening session on occasion, if assigned Seeing patient’s work-in patients when necessary Requesting time off at least one month in advance, if possible Supervising advance practice nurses in Clinic when assigned Provide consultation and prescription signatures to advance practice nurses when needed Provides hospital care as assigned which includes: Making daily patient hospital rounds Overseeing residents in the management of hospital patients Writing daily progress notes in hospital charts Taking phone calls about hospital patients Team Contributions The physician contributes to team efforts which include: working with others to develop effective solutions to issues providing support and training to co-workers when needed modeling and encouraging positive staff interactions participate in assigned Quality Assurance/Management in Daily Work activities regularly attend QA/TQM as required Regularly attends Clinic/team/staff meetings as required Administrative Activities Participating in the physician performance audit as assigned Assist in the development and maintenance of HealthLinc practice guidelines (protocols) as assigned Participating in Total Quality Management (TQM) activities. Many of these sessions may occur at 8:00 a.m. or over the lunch period. Attend Clinic’s Provider Group Meetings and hospital section meeting as scheduled attend required in-service meetings attend other meetings as assigned Community-Oriented Activities The physician participates in community-oriented activities which include Making presentations in the community when requested Attending annual board, staff, volunteer meetings and/or dinners Attending HL Board Meetings; if requested Representing the Physician staff at the HL Board if requested