Primary Care Physician Lead

CenterWell-posted 4 days ago
Full-time • Mid Level
Savannah, GA
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Become a part of our caring community and help us put health first Humana’s Primary Care Organization is one of the largest and fastest growing value-based care, senior-focused primary care providers in the country, operating over 340 centers across fifteen states under two brands: CenterWell & Conviva. Operating as a payor-agnostic, wholly owned subsidiary of Humana, our centers put the unique needs of seniors at the center of everything we do. Our Clinics offer a team-based care model where our physicians lead a multi-disciplinary care team supporting patient’s physical, emotional, and social wellness. At CenterWell Senior Primary Care we want to help those in the communities we serve, including our associates, lead their best lives. We support our associates in becoming happier, healthier, and more productive in their professional and personal lives. We promote lifelong well-being by giving our associate fresh perspective, new insights, and exciting opportunities to grow their careers. Our culture is focused on teamwork and providing a positive and welcoming environment for all. The Physician Lead serves as a health-care professional and capable of handling a variety of health-related problems. The Physician Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Physician Lead (PL) serves as a leader to a team of clinicians in a designated market responsible for handling a variety of health-related problems and educating patients and their families on wellness, prevention, and early detection. The PL is responsible for executing the clinical strategy through the management of their own patient panel as well as those of the clinicians whom they lead. The PL reports directly to the Market CMO and is directly responsible for Administrative oversight and outcomes determined by the Clinical / Operational Leadership of the Market Spend a portion of time clinically-focused on direct patient care, with the remaining time dedicated to administrative duties related to oversight of clinical provision of care including, but not limited to: Working collaboratively with Market CMO and Operational Leadership to: Advance the Model of Care Create profit improvement initiatives Design operational implementations Contribute to the strategic intent

  • Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) in: Maintaining Collaborative / Supervisory Agreements per state protocols
  • Assisting with panel management
  • Providing direct education to clinicians around clinical protocols / disease prevalence / appropriate levels of clinical quality care
  • Providing guidance to individual clinicians about patient terminations, in collaboration with Compliance
  • Supporting clinicians with schedule templates, coverage, daily issues
  • Managing behavioral concerns of supervised staff
  • Assisting with PTO Management
  • Assisting with CME time and reimbursement requests
  • Assisting with completion of performance reviews
  • Assisting in resolution of inquiries, requests, and complaints from clinical staff
  • Assisting in organizing team building activities
  • Assisting in resolution of inquiries, requests, and complaints from patients
  • Ongoing chart review / audit of clinical staff to ensure quality care and identifying opportunities for education/coaching
  • Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management) to impact Part D per Member per Month (PMPM) costs while maintaining high quality care
  • Optimizing network; preferred network specialists – contributing to the identification of preferred network specialists to optimized delivery of care for ongoing maintenance / cost saving opportunities
  • Making decisions related to the identification and mitigation of complex technical and operational problems within clinics/centers
  • Managing financial / operational performance of their assigned clinics to ensure success
  • Participating in provider committees (i.e. Technology Governance, EMR Optimization, etc.) and attending meetings regularly
  • Participating in Shared Service Strategy Meetings
  • Participating in quality improvement programs, population health programs, continuing education, and other patient care programs established by clinical requirements
  • Assisting in recruiting and interviewing of potential clinical staff
  • Participating in patient retention and marketing activities as required
  • Serving as a community representative in the media and press activities
  • Other duties as directed by the Market CMO
  • Maintaining confidentiality of all patient information according to both state and federal guidelines and regulations
  • Maintaining medical history and medical records
  • Ordering studies, tests and ancillary services
  • Participating as a back-up on-call physician
  • Prescribing medical treatment and clinical drugs to patients
  • Referring patients to specialists as needed
  • MD/DO
  • 8 or more years of technical experience
  • 2 or more years of project leadership experience
  • Licensure requirements of the state of jurisdiction
  • Graduate of accredited MD or DO program of accredited university
  • Prefer Internal Medicine specialty
  • Board Certification in Family Medicine, Internal Medicine or Geriatric Medicine
  • This role is considered patient facing and is part of Humana/Senior Bridge's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  • Active and unrestricted DEA license
  • Medicare Provider Number
  • Medicaid Provider Number
  • Minimum of three to five years directly applicable experience preferred
  • Experience managing Medicare Advantage panel of patients with understanding of Best Practice in coordinated care environment in a value based relationship environment.
  • Knowledge of Medicare guidelines and coverage.
  • Knowledge of HEDIS quality indicators
  • Good understanding of best practice coding and documentation in value based environment
  • Leveraging Technology: You are technological savvy and know how to appropriately share and use your knowledge to improve business results.
  • Problem Solving: You are a problem solver with the ability to encourage others in collaborative problem solving. Acting as both a broker and consultant regarding resources, you engage others in problem solving without taking over.
  • Accountable: You meet clearly stated expectations and take responsibility for achieving results.
  • Clinical Knowledge: You understand clinical program design, implementation, management/monitoring to support choice in consumer medical care. Understands the medical utilization implications of such programs
  • Communication: You actively listen to others to understand their perspective and ensure continuous understanding regardless of communication channel or audience.
  • Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
  • Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
  • Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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