Physician - Family Medicine Or Internal Medicine (Medical Optimization/Chronic Disease Management)

Overview Job Summary: Central Health is seeking a physician, board certified in Family Medicine or Internal Medicine to join our Pre-Operative Assessment and Medical Optimization Programs.  This role requires a thorough understanding of various medical conditions, their impact on surgical outcomes, and strategies for optimizing patients' health preoperatively. The Pre-Operative Assessment program will risk stratify patients undergoing surgery or procedures requiring anesthesia.  It will require communication and collaboration with specialists for complete evaluation.  

Patients who have been determined to be high risk or have uncontrolled chronic health conditions during the pre-operative assessment or who are identified during a visit at the Central Health Multi-specialty clinic, will be cohorted for intensive disease management in our Medical Optimization program.  As a member of our multi-disciplinary team, this will require close collaboration with specialists, pharmacists, and dietitians to provide comprehensive care tailored to each patient's needs.  

Job duties include direct patient care to referred patients via face-to-face visits or telehealth. This position requires supervision of advanced practice providers, students, residents and fellows.

Responsibilities Essential Job Functions: -Conduct a detailed review of the patient's medical history, including past surgeries, chronic medical conditions, medication history, allergies, and family history of anesthesia-related complications.

-Perform a thorough physical examination to assess the patient's overall health status, including vital signs, cardiovascular, respiratory, neurological, and musculoskeletal systems.

-Review the patient's current medication regimen, including prescription medications, over-the-counter drugs, and supplements. Adjust medications as needed to optimize perioperative management, including considerations for drug interactions, perioperative discontinuation or continuation, and medication titration.

-Order and interpret appropriate laboratory tests and diagnostic studies to assess the patient's baseline health status and identify any abnormalities that may impact perioperative management.

-Evaluate the patient's perioperative risk based on their medical history, physical examination findings, and results of laboratory and diagnostic testing. Stratify patients into low, moderate, or high-risk categories to guide perioperative management decisions.

-Collaborate with the patient's primary care provider and specialists (e.g., endocrinologist, cardiologist, pulmonologist) to optimize the management of chronic medical conditions prior to surgery. This may include medication adjustments, initiation of additional therapies, lifestyle modifications, and referral for further evaluation or intervention as needed.

-Provide patient education regarding the importance of preoperative optimization, adherence to medication regimens, perioperative expectations, and strategies for mitigating perioperative risks.

-Address any concerns or questions the patient may have regarding their surgical procedure and perioperative care.

-Educate patients on their conditions, treatment options, and self-management strategies to empower them to take an active role in their health and wellness.

-Communication with Surgical Team and Anesthesiologist: Communicate findings, recommendations, and perioperative risk assessment to the surgical team, including the operating surgeon and anesthesiologist, to facilitate informed decision-making and coordination of care.

-Ensure accurate and thorough documentation of the preoperative assessment, medical optimization interventions, perioperative risk assessment, and communication with the patient's healthcare team in the medical record.

-Establish a plan for postoperative follow-up and continuity of care to monitor the patient's recovery, manage any perioperative complications, and ensure ongoing management of chronic medical conditions beyond the surgical encounter.

-Provide holistic care to patients, incorporating medical, pharmaceutical, and nutritional interventions to optimize health outcomes and quality of life.

-Collaborate effectively with specialists, pharmacists, and dietitians to develop and implement individualized care plans for patients, ensuring coordinated and comprehensive care.

-Utilize remote patient monitoring technologies and review patient data to track progress, identify trends, and adjust treatment plans as needed to optimize patient outcomes.

-Participate in program evaluation and quality improvement initiatives to enhance the effectiveness and efficiency of the medical optimization program.

-Works in tandem with Central Health's operational and clinical leaders to ensure a collaborative team-oriented environment.

-Leads and motivates the medical providers under their supervision; uses effective medical and people performance management processes.

-Serves as the champion for initiatives that may impact the operations of Central Health and/or the quality of patient care.

-Performs or supports objective annual evaluations of all direct reports with the input from the practice leader and other stakeholders.

-Work within the scope of credentialing privileges.

-Supports, leads, and models the vision, mission, and values of Central Health.

-Perform other duties as assigned.

Knowledge, Skills and Abilities: -High level of skill at building relationships and providing excellent customer services.

-Interpersonal savvy and influence skills in managing difficult clients and patients.

-High degree of knowledge and competency in the practice of medicine and associated charting requirements.

-High level of problem-solving skill to better serve patients and staff.

-Strong attention to detail and accuracy.

-Ability to utilize computers for data entry and information retrieval.

-Ability to manage multiple responsibilities and emergency situations successfully.

-Excellent verbal and written communication skills.

-Ability to implement and evaluate operational and emergency situations successfully.

-Demonstrated understand of and/or experience working in a patient centered medical home (PCMH)

environment.

-Demonstrated understanding and/or experience working in an integrated delivery environment.

Qualifications Required Licenses/Certifications: -Unrestricted licensed to practice medicine in the State of Texas. 

-Board Certification in Family Medicine or Internal Medicine or passage of Board Certification examination within two (2) years of employment

-Current Drug Enforcement Agency (DEA) for the purpose of writing prescriptions

-Current Basic Life Support Certification for Healthcare Providers through American Heart Association or American Red Cross

Required Education: -M.D. or D.O. from an accredited educational institution

Required Experience: - 1 year in related field

Preferred Experience: -Chronic disease management, Perioperative services

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