Lead Primary Care Physician

Full-Time Direct Hire Role Duties

• Provide excellent primary care to a panel of members, leading your pod interdisciplinary care team
• Coach fellow providers in how to provide excellent primary care / urgent care / or community care to their members, and effectively lead their interdisciplinary care teams.
• Mentor care teams during population health huddle to achieve their quality and utilization goals.
• Alongside the Medical Director, the Lead Physician is the clinical leader in the center.
• They address questions from and provide clinical guidance to nurses, MAs, and fellow providers about clinical cases as they arise.
• The Lead Physician is core part of the center and market’s leadership team. They are accountable for driving the market toward successfully achieving its quality, utilization and engagement goals.

• Provide Primary Care services to panel of members.
• Work in a team environment (with social work, care management, behavioral health, nursing, pharmacy, nutrition, etc.), process feedback, and facilitate discussion and implementing plans of care from other members of the team.
• Coach and mentor physicians and Advance Practice Providers.
• Treatment of acute exacerbations of chronic conditions onsite.
• 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 to ensure acute episode has resolved and the patient is not admitted/readmitted.
• Possess a comfort level and the knowledge to differentiate when exacerbation can be treated within client and when a higher level of care is needed.
• Work with Medical Director to forge partnerships with academic programs and community-based organizations to enhance provision of services to members.
• Vigilant in keeping track of patients and their disease processes to prevent ER visits, admissions to the hospital, and readmissions.
• Practice evidenced based medicine and in accordance with the PCMH model of care.
• Able to keep track of and successfully obtain specified quality metric goals.
• Perform other duties as required consistent with chronic care and disease management services provided to patients.
• Implement plans of care in collaboration with the patient, their family and other team members.
• Develop strong transitional care plans and able to keep track of paneled patients along the whole continuum of care including hospital discharges, ER, skilled nursing facilities and home care.
• Track and successfully obtain specified quality metric goals.
• Use technology and the electronic health record to the highest capability to increase quality initiatives and efficiency within the practice.
• Participate in multi-disciplinary meetings and recommend treatment initiatives designed to keep patients healthy or resolve ongoing clinical issues.
• Provide on-call coverage for the office in rotation with other providers.
• Develop clinical protocols and pathways to upskill all clinical support staff to practice top of license
• Approximately 70-80% time dedicated to direct clinical care.
• Other duties as assigned.

• Active, unrestricted medical license in the state of employment.
• 1-5+ years of clinical experience and administrative experience leading interdisciplinary teams.
• Experience working for a clinic, community-based organization & inpatient unit.
• Experience with training and mentoring.
• Excellent interpersonal communication skills.
• Strong problem solving, project management and organization skills.
• Independent self-starter and critical thinker interested in population health, healthcare utilization management, and the ongoing development of our care model.