The posting
Job Description
Flexible Schedule
Many employers say they offer work-life balance, but few deliver on that promise. CareConnectMD providers are expected to complete their work as professionals and do not practice on a shift basis, enjoying the flexibility to adjust their work schedule around their families and other important priorities. We do not have 12-hour on-site work shifts or extensive after-hour clinic work duties. Retention is important to us, so we want to make sure our providers can maintain a good quality of life. CareConnectMD provides after-hours call coverage support, so you can enjoy your time away from work without being interrupted by calls.
Key Duties and Responsibilities
- Provide physician coverage for a dynamic service area, usually including 8 to 20 skilled facilities, depending on geographic distance, patient volume, etc. Covered facilities may be added or changed to meet current contractual needs.
- Determine and conduct an appropriate rounding schedule to accommodate skilled and custodial patient visit requirements
- Conduct and appropriately document timely patient visits in compliance with clinical need and regulatory requirements.
- Efficiently manage long-term care (custodial) patients, including ACO REACH patients in nursing facilities
- Participate in brief daily rounds for ACO REACH patients – discuss the change in status, condition with ACO REACH medical director
- Manage medical care of patients on skilled days; ensure adequate visits according to contract requirements and medical necessity; effect safe and timely discharge from skilled level of care. Requirements are defined in accordance with applicable legal and regulatory standards
- Conduct (or delegate, as appropriate) timely monthly visits to all custodial patients in designated service area in accordance with California Title 22 requirements.
- Respond to direct phone calls and pages from 7:00 AM to 6:00 PM, Monday through Friday, according to CCMD policy (see Clinical Operations Manual; Section 3, Communications).
- Initiate adequate daily communication with Call Center for review and follow-up of non-critical calls, pages, requests for orders, lab results, etc. Provide clear direction for nurse callbacks.
- Thorough and accurate medical documentation of all visits using SOAP format in group EMR.
- Dictate timely discharge summary for skilled patients returned to care of PCP.
- Participate equally in shared daytime weekend call with option to participate in overnight and weekend call for additional pay
- Participate in QI program and Peer Review
- Participate in utilization management program
- Attend medical staff meetings
- Active, ongoing patient/family communication.
- Appropriate CPT and ICD10 coding and daily submission of billing forms to office.
- Timely completion of all medical records and signing of telephone orders and charts in accordance with facility and other applicable requirements and regulations.
Rounding
The Supervising Physician is responsible for coordinating rounding schedules and team-specific work processes in collaboration with the clinical team. Patient visits are prioritized based on new admissions, (whether patients are skilled or custodial), acuity of skilled patients, any changes in patient condition, follow-up of on-call phone log activity, family requests and routine (for subsequent custodial visits).
Generally, Nurse Practitioners will be available to perform the admission history and physical, alternate routine custodial visits, and regular skilled and medically necessary visits as appropriate. They will also support the physician by handling laboratory results and responding to family and facility calls regarding patient care. These activities need to be coordinated between team members so that expectations are clear. Urgent pages require response within 15 minutes and routine pages within 60 minutes. In any case where clinical concerns or risk or quality issues exist, the NP is responsible for addressing these with the supervising physician. (See Figure 2.1)
Rounding is usually done Mondays through Fridays, although flexible schedules for weekend rounding may be arranged in consultation with the Supervising Physician.
Visit Requirements
Both physicians and nurse practitioners perform patient visits. Requirements for various types of visits are defined in accordance with the Federal Omnibus Reconciliation Act of 1987 (OBRA), Title 22, Physician Responsibility Standards, applicable state law (see Appendix D, Legal and Regulatory) and individual facility policies. Nurse Practitioners will perform authorized medical services utilizing approved standardized procedures as contained in the Nurse Practitioner Standardized Procedures Manual (Appendix F, Nurse Practitioner Standardized Procedures.).
New Admissions
Either the physician or nurse practitioner may perform the admitting History and Physical (H&P) within the nursing facility unless the patient has traditional Medicare insurance. In this case, the NP may do the initial visit, however the physician is required to complete the History and Physical within 72 hours of admission. The supervising physician will countersign any nurse practitioner H&P and will see the patient as medically necessary.
Skilled Visits
Skilled patients must be seen at least twice weekly. These visits may be performed by the physician or nurse practitioner, at the discretion of the supervising physician. Complexity of the case or any change in condition should be considered in making this judgment.
REACH ACO Visits
Long-term care (custodial) patients that are part of our ACIO REACH High Needs program should have 2 provider visits a month. One of every 3 visits should be by the physician and the other 3 can be performed by either the physician or nurse practitioner as clinically indicated.
Custodial Visits
Under California's Title 22, custodial visits are required every thirty days. The physician and NP may perform alternate routine monthly visits to custodial residents.
Medically Necessary Visits
The physician or nurse practitioner may see a patient for a repeat visit based on medical necessity, such as a change in condition or at the request of the family or patient. Any serious or significant clinical issue or change in status encountered by the NP requires notification of the supervising physician (see Title 22, Appendix D, Legal and Regulatory). Reasons for and findings of medically necessary visits must be well documented.
Transfers to Acute Facilities/ER Evaluation
It is CCMD policy to notify the accepting physician when a skilled nursing patient is sent to an acute hospital or ER for an unplanned event or acute change in condition to ensure continuity of care. All unplanned transfers to acute level of care will be recorded on the Team Monthly Report.
Planned Discharges
A dictated Discharge Summary needs to be completed for all planned discharges of patients who leave a facility for a lower level of care, including home, Board and Care and Assisted Living. A copy of the Discharge Summary is provided to the Primary Care Physician (PCP) of contracted medical groups for continuity of care.
Patients who expire, return to an acute hospital, are transferred to another skilled nursing facility or transition over to custodial residents in the same facility do not require a discharge summary although it is reasonable to perform one for continuity's sake.
Education and Experience
- MD or DO degree and completion of a board-recognized specialty
- Background in internal medicine, geriatrics and/or palliative care
- Medical malpractice insurance policy in force (provided for full-time employees)
- Managed care experience preferred
Essential Skills and Abilities
- Self-starter that can work independently and collaboratively, prioritize tasks and has initiative and excitement to take on unfamiliar tasks.
- Advanced knowledge of word processing, graphic presentation and computer software related to specific tasks
- Demonstrated excellent computer and word processing skills with special emphasis on calendaring, presentation, and spreadsheet capabilities
- Excellent composition, grammar, and clinical documentation skills
- Excellent communication and interpersonal skills with the ability to effectively communicate with all levels of management, patients, and family members.
- Creative, flexible, well organized, resourceful, and detail-oriented
- Excellent judgment in handling confidential and sensitive information
- Ability to work independently, set priorities and handle multiple tasks with a high level of efficiency
- Able to establish and maintaining cooperative and positive work relationships
- Ability to work across locations
Licenses/Certifications
- Current State of California medical license
- Current Drug Enforcement Administration (DEA) Certificate
- Current CPR certification (BLS)
Core Competencies
- Instills trust
- Customer focus
- Manages ambiguity
- Collaborates
- Drives results
