Primary Care Physician - 3091

AbsoluteCARE Medical Center & Pharmacy; Baltimore (MD); On-site; USD 180,000 - 240,000; Full time

Job summary

AbsoluteCARE Medical Center & Pharmacy seeks a physician to lead and coordinate care for patients with multiple chronic conditions. You will work with a multidisciplinary team including social work, case management, behavioral health, pharmacy, and nutrition to implement comprehensive plans of care.

The role emphasizes transitional care, discharge planning, and preventing readmissions through evidence-based, PCMH-aligned care.

Qualifications

• Licensed physician in the state of Practice.
• Board certified in Internal Medicine or Family Practice.
• BLS certification required.
• Mission-driven to serve the underserved.
• Ability to work as part of a multidisciplinary team with constant collaboration.

Responsibilities

• Focus on management and improvement of health for patients with multiple complex and chronic conditions.
• Lead a team with social work, case management, behavioral health, pharmacy, nutrition, etc.
• Develop transitional care plans and track paneled patients through hospital discharge to home care.
• Coordinate with hospital, ER, SNF, and other facilities to facilitate appropriate discharge.
• Treat acute exacerbations of chronic conditions within AbsoluteCarecenter.
• Accept same day/next day or urgent appointments for high-need patients.
• Keep vigilant track of patients to prevent ER visits and readmissions.
• Educate patients on chronic disease progression and advanced directives.
• Practice evidence-based medicine within the PCMH model.

Skills

Team leadership

EMR experience

Multidisciplinary collaboration

Problem solving

Education

Board certification: Internal Medicine or Family Practice

BLS certification

Licensed physician in state practice

Tools

EMR systems

Job description

Specific Duties and Responsibilities:

Complex Clinical Care:

• Focuses on the management and improvement of health for patients with multiple complex and chronic medical conditions.
• Able to work with and lead a team (with social work, case management, behavioral health, pharmacy, nutrition, etc.), process feedback, and be open to discussing and implementing plans of care from other members of the team.
• Develop strong transitional care plans and able to help keep track of paneled patients along the whole continuum of care including discharges from the hospital, ER, skilled nursing facilities/nursing homes, and home care.
• Communicate and interact with alternate levels of care facilities (hospital, ER, skilled nursing facilities) to facilitate appropriate discharge to a lower level of care or back to the AbsoluteCareMedical Center. Familiar with inpatient medicine and the discharge process to help facilitate discharges.
• Treat acute exacerbations of chronic conditions within the AbsoluteCarecenter, i.e. Lasix for CHF, IVF for Dehydration/Renal Failure, IV antibiotics for various infections, Nebulizer/Solumedrol for COPD/Asthma etc. Possess a comfort level and the knowledge to differentiate when exacerbation can be treated within AbsoluteCareand when a higher level of care needed.
• Accept same day/next day or urgent appointments for patients from home or discharged from the hospital/ER/skilled nursing facility in need of intensified physician or case management/social work services to ensure acute episode has resolved and the patient is not admitted/readmitted.
• Vigilant in keeping track of patients and their disease processes to prevent ER visits, admissions to the hospital, and readmissions.
• Understand the PCMH model of care as pertains to specialist care, only utilizing this higher level of care as needed, and not a substitute for a well-trained primary care physician with evidence based clinical skills.
• Educate members on chronic disease progression and the need for advanced directives where applicable.
• Practices evidenced based medicine and in accordance with the PCMH model of care.

Candidate Qualifications:

• Licensed Physician in the state ofPractice
• Board certified in Internal Medicine or Family Practice
• BLS certification required
• Mission-Driven to serve the underserved
• Work without ego, and thoughtfully build successful relationships with team members and our partners
• Ability to work as part of a multidisciplinary team with constant collaboration within and across provider teams
• Experience and comfort utilizing EMR
• Problem-solving and the ability to be creative in those solutions

Preferred qualifications:

• Experience in population health management
• Experience in working with psycho-socially and medically complex patient population