Manages and provides acute, chronic, preventive, curative and rehabilitative medical care to patients and determines appropriate regimen in specialized areas such as family practice, internal medicine and geriatrics with experience in transitions of care, chronic disease, advanced goals of care discussion and palliative management. Supports the implementation of the six standards of the patient-centered medical home model of care to promote: Patient-Centered Access for both routine and urgent needs of patients/families/caregivers at all times. Team-Based Care by providing continuity of care using culturally and linguistically appropriate, team based approaches Population Health Management by supporting evidence based decisions and proactive care reminders based on complete patient information, health assessment and clinical data. Care Management and Support through systematically identifying individual patients and their action plans, and manages and coordinates care based on need. Care Coordination and Care Transitions across specialty care, facility-based care and community organizations. Performance Measurement and Quality Improvement by using data to identify opportunities for improvement and acts to improve clinical quality, efficiency and patient experience.
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Job Type
Full-time
Career Level
Senior