About the position
Monogram Health is seeking a full-time physician, specialized in palliative care, to join the team due to continued nationwide growth. This physician will be an in-market specialist and care for the seriously ill population in their community, including patients with CKD/ESRD, COPD, and CHF. The Lead Palliative Care physician will be integrated into their local market with the Market Physician Executive (MPE) and primarily renders care in the home. Monogram Health physicians are quality-driven physicians who apply their clinical expertise in a managed care, population health context. They also engage in population health management in a sophisticated, outcomes-driven manner that promotes palliative care where clinically appropriate and focuses on patient quality of life, education, and shared-decision making.
Responsibilities
- Collaborate with MPE and the care team to proactively identify patients who qualify for palliative care services and build a patient panel
- Developing and presenting metrics to executive leadership, as requested
- Responsible for the outcomes for patient panel, driving both predetermined clinical and financial Key Performance Indicators (KPIs) through interventions outlined below
- Treat panel of patients in-home to drive healthcare outcomes
- Evaluate and treat symptoms that may interfere with quality of life, like pain, pruritis, depression, anxiety, insomnia, etc.
- Refer members to appropriate specialists to drive clinical care (Monogram-based specialists or locally-aligned specialists)
- Conduct goals of care and family meetings as needed and document patient/family wishes in state AD/POLST forms
- Support patients utilizing our IDT, including Palliative Care Chaplain
- Assist with hospice transitions as appropriate
- Develop key relationships with local providers (PCP, nephrologists, specialists) to improve market alignment
- Participate in monthly meetings with RMD/CMO in areas of KPI and expectations around KPIs
- Educate and support team around palliative care, hospice care, advance directives, symptom assessment, and communication
Requirements
- Desire to practice in a forward-looking renal care environment focused on population health management
- Demonstrated experience applying evidence-based clinical criteria
- Comfort and skill in goals of care discussions and advance care planning
- Experience with high-need Medicare Advantage and managed Medicaid populations, as well as commercial populations
- Experience integrating acute and behavioral health care and appreciation of social determinants of health and the value of social workers
- Expertise in managing medication panels for complex patients
- Current state medical license without restrictions to practice and free of sanctions from Medicaid or Medicare
- Willingness to become licensed in multiple states as company and patient needs require
- Doctorate Degree in Medicine
- Board Certified in Hospice and Palliative Medicine
- Must have reliable transportation
Benefits
- Opportunity to work in a dynamic, fast-paced and innovative organization that is transforming the delivery of polychronic disease care
- Autonomous schedule with In-home visits in a value-based care model
- Competitive salary plus company bonus program
- Full benefits including medical, dental, vision and life insurance
- Paid time off and 401(k) with matching contributions
- Relocation assistance and sign on bonus on case-by-case
