Home Care Physician - Buffalo, NY - Sign On Available

About the position

Evernorth Home Based Care (ENHB), a division of The Cigna Group, is the premier home-based healthcare provider and medical services company. We are an innovative, multi-specialty practice experiencing tremendous growth nationwide. At ENHB, our focus is comprehensive care at home to improve outcomes and reduce total healthcare costs. We are a group of clinical professionals that understand the needs of patients, medical professionals, health systems, and payers. A main focus of our practice is conducting Comprehensive Health Risk Assessments (HRA) in-home to ensure patients' medical well-being and to provide accurate data for HCC (Hierarchical Condition Categories) coding, STAR ratings, and reimbursement. Our In Home Primary Care Program (Model 2) allows health plans to conduct in-home longitudinal care for medically complex patients with chronic illnesses to improve clinical outcomes. Our team collaborates with the patients' primary care physicians (PCPs), and our visits serve as an adjunct to the care delivered by the PCP. In Home Primary Care Program (Model 1) involves ENHB contracting with health plans to assume primary care of chronically ill patients with high admission rates and multiple emergency department visits to improve clinical outcomes. Nurse practitioners work alongside physicians delivering care in the patient's home. As a Home Care Physician, you will function as the day-to-day clinical leader, providing decision support to nurse practitioners and collaborating with the multidisciplinary team. You will perform preventive visits daily to optimize chronic conditions, assess home environments, and develop proactive care plans. Educating patients and their families on chronic medical conditions, preventative care, and medication adherence compliance will be a key part of your role. You will also perform urgent care visits in the home and telephonically to avoid unnecessary ED transfers and hospital admissions, leveraging the support of the care team to meet patients' medical, biopsychosocial, and financial needs. In addition, you will coordinate with other physicians across the continuum of care, including hospitalists, specialists, and PCPs, to smooth transitions and prevent readmissions. Completing appropriate and thorough clinical documentation of acute and chronic health issues through patient encounters in the EMR system is essential, as is participating in quality processes such as medical documentation audits and quality projects. You will also serve as a mentor or coach to advance practice providers in ongoing quality and performance improvement processes.

Responsibilities
?? Function as day-to-day clinical leader, providing decision support to nurse practitioners and collaborating with the multidisciplinary team
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?? Perform preventive visits daily to optimize chronic conditions, assess home environment, and develop proactive care plans
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?? Educate patients and/or patient's family on chronic medical conditions, preventative care, and medication adherence compliance
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?? Perform urgent care visits in the home and telephonically to avoid unnecessary ED transfers and hospital admissions
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?? Leverage the support of care team such as nurse care manager, behavioral health, social work, and pharmacy to meet patients' medical, biopsychosocial, and financial needs
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?? Assume responsibility as home based PCP in some cases where there is no PCP and in other cases co-manage the patient with the PCP
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?? Coordinate with other physicians across the continuum of care, including hospitalist, specialists, PCP's, and SNF providers to smooth transitions and prevent readmissions
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?? Perform Telehealth visits when needed
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?? Complete appropriate and thorough clinical documentation of acute and chronic health issues through patient encounter in EMR system
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?? Complete EMR documentation in a timely manner; ensuring all appropriate consent forms are signed and dated
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?? Interpret laboratory data and diagnostic testing when available to assist in diagnosis of medical conditions
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?? Perform ADL and fall risk assessments; cognitive impairment, depression, and nutritional health screening; BMI measurement; medication reconciliation
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?? Participate in frequent telephonic clinical meetings and web-based trainings; attend on-site training for which the provider will be reimbursed
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?? Complete chart reviews for advanced practice providers as determined by market
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?? Participate in quality processes such as medical documentation audits and quality projects
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?? Serve as a mentor or coach to advance practice providers in ongoing quality and performance improvement processes
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?? Improve provider relations through direct communication and fostering positive collegial relationships
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?? Perform other duties as assigned by the practice manager or medical director
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?? Perform HRA (health risk assessments) on patient panel
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?? Collaborate with the multidisciplinary team which may include patients' PCPs and health plan case managers
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?? Share after hour on-call coverage with other providers on the team
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?? Work with telephonic/office nurse care coordinators and case managers
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?? Work with telephonic social workers (practice dependent)
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?? Work with office medical assistants
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?? Have the ability and the experience to prescribe medications, order labs or diagnostic testing, and recommend sub-subspecialty referrals

Requirements
?? Board Certification (MD or DO) in Internal Medicine or Family Medicine
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?? Active/unrestricted license in NY
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?? Geriatric Medicine subspecialty training or experience preferred
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?? DEA license and State Controlled Substance license upon hire
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?? Current BLS certification
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?? Willingness to travel up to a 30-60 mile radius from home zip code
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?? Valid state driver's license and proof of adequate automobile insurance
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?? Ability to be credentialed by Medicare, Medicaid, and other Private Insurance Companies
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?? Experience with electronic medical records is required
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?? Proficiency with various computer-based applications such as Microsoft Office
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?? Strong organizational skills and comfortable working independently
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?? Strong background/interest in primary care and preventative medicine
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?? Excellent clinical assessment and analytical skills
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?? Effective leadership and interpersonal skills
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?? Excellent verbal and written communication skills
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?? Proven ability to perform comprehensive adult and geriatric physical exams
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?? Demonstrated ability to identify, diagnose and document acute and chronic disease in adults
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?? Demonstrated ability to recognize conditions, characteristics, and behaviors that place seniors at risk
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?? Proven ability to pursue feedback, continuing education and professional development
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?? Proof of yearly influenza vaccination, Hepatitis B vaccination, and TB testing required

Nice-to-haves
?? Experience in home-based care settings
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?? Familiarity with telehealth technologies
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?? Experience in managing complex care patients
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?? Knowledge of health plan operations and requirements

Benefits
?? Medical, vision, and dental insurance
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?? 401(k) with company match
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?? Company paid life insurance
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?? Tuition reimbursement
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?? Minimum of 18 days of paid time off per year
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?? Paid holidays
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?? Annual bonus and long-term incentive plan

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