PHYSICIAN

Job Description

Job Description

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 daily rounds Monday through Friday
• Manage ACO REACH patients in the LTC facilities
• Participate in daily rounds for ACO REACH patients – discuss the change in status, condition with ACO REACH medical director
• Communicate with patients’ families
• 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.
• Dictate discharge summary for skilled patients returned to care of PCP.
• Participate in paid night and weekend call
• Participate in QI program and Peer Review
• Participate in utilization management program
• Attendance at 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, sign telephone orders and charts in accordance with facility and other applicable requirements.

Rounding

The Supervising Physician is responsible for determining rounding schedules and team-specific work process in collaboration with the clinical team. Patient visits are scheduled 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 custodial visits.

Generally, Nurse Practitioners will perform the admission history and physical, alternate routine custodial visits, skilled and medically necessary visits as appropriate, handle laboratory results, and respond to family and facility calls regarding patient care. 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.).

Visits are considered timely if they occur no later than 10 days after the visit was required.

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 once 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

REACH ACO visits are required once every 6 weeks.

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, family, or patient request. 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 is 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, or return to an acute hospital, or transferred to another skilled nursing facility or remain as custodial residents do not require a discharge summary.

Flexible Schedules

Many employers say they offer work-life balance, but few can deliver on that promise. CareConnectMD providers do not practice on a shift basis, so they have more flexible schedules that work around raising their families and other important priorities. With us, there are no surprise 12-hour work shifts or increasing unpaid time for after-hour clinic work duties. Retention is important to us, so we want to make sure our providers enjoy great qualities of life. CareConnectMD provides after-hours call coverage support, so you can enjoy your time away from work without being interrupted by calls.

Education and Experience

Essential Skills and Abilities

Licenses / Certifications

Core Competencies

To ensure the health and safety of our workforce while doing our part to protect those around us, CareConnectMD is requiring proof of full COVID vaccination for employees as a condition of employment, subject to legally recognized accommodations.