PACE – Medical Director

Jacksonville, FL 32205

The Medical Director provides general medical direction and supervision of the medical aspects of care for PACE Organization. The Medical Director is responsible for the delivery and oversight of participant care, clinical outcomes, implementation and oversight of the quality assessment and performance improvement program, utilization management, development and maintenance of medical policies and procedures/standards and protocols. The Medical Director will provide direction and supervision to primary care physicians, nurse practitioners, nursing staff and allied health services and leadership of the program among staff, colleagues, and providers in the community.

• Duties and Responsibilities:
• Oversight and responsibility for the PACE Quality Program
• Understand the regulations related to Quality Assessment and Performance Improvement (QAPI) and PACE and the medical director’s role.
• The medical director is responsible for the delivery of participant care and clinical outcomes.
• Proactively develop a collaborative working relationship with the quality manager.
• Assume overall accountability and responsibility for the medical care of the participants.
• Oversee the medical service team to promote quality and outcome goals.
• Overall responsibility for the implementation and oversight of the QAPI activities, and QAPI plan. Studies data, reviews procedures, identifies problems and makes necessary corrections to ensure the QAPI plan is viable, and data has integrity.
• Chair of the Quality Assurance Committee.
• Provide medical oversight in the development of standards and uniform treatment policies and procedures to assure they are inclusive of the knowledge and values which guide PACE Partners of NE FL.
• Develop and maintain written objectives, polices and procedures, an organizational plan, and a quality assurance program for the medical service. All medical policies shall be reviewed at least annually.
• Coordinate and integrate medical services with other participant care services to provide a continuum of care for the participants
• Develop, implement, and monitor outcome measurements to assure appropriate and efficient utilization of all health care services including:
• Hospital inpatient and ER utilization
• Pharmaceuticals
• Specialist referrals
• Medication management
• Nursing facility utilization
• When utilization problems are identified, research best practices and work with clinical staff and interdisciplinary team to make appropriate procedural and or operational changes to bring utilization into alignment with established PACE best practices.
• Supervise [PACE Organization] primary care practitioners:
• Recruit and train primary care physicians and geriatric nurse practitioners
• Assist in developing and maintaining written job descriptions for the medical staff. Participate in the review of credentials and delineation of privileges of medical staff members, and assign duties based upon education, training, competencies, and job descriptions.
• Participate in annual performance evaluations of Primary Care Physicians and Nurse Practitioners.
• Consult with primary care staff to discuss clinical and case management issues
• Monitor clinic operations to assure integration of primary care and nursing services
• Oversee and ensure appropriate diagnostic coding practices of Primary Care Physicians.
• Participate in primary care, hospital and nursing home rounds, and the 24-hour on-call system to assure continuity of care for PACE participants.
• Ensure that medical staffing patterns are implemented
• Act as community liaison with physician groups, specialists, and hospitals to represent [PACE Organization] and assure good provider relationships.
• In conjunction with the Executive Director, participate in contract negotiations and monitoring with medical and health related providers.
• Provide leadership with medical staff, promoting the goals and needs of [PACE Organization] and those it serves.
• Participate with the executive management group in internal operations, program development and resource utilization.
• Participate in staff orientation and staff education activities.
• Participate in continuing education and training of all [PACE Organization] staff.
• Participate in the National PACE Association physician network to assure representation and recognition.
• Identify opportunities for clinical and health care delivery research which will enhance the geriatric leadership role of [PACE Organization] in clinical expertise and innovation.
• When acting as Primary Care Physician, maintain daily attendance at and participate in interdisciplinary team meetings, communicating participant changes, collaborating on care planning decisions and coordination of 24-hour care delivery.
• When acting as Primary Care Physician, evaluate and treat participants during acute illness. Oversee and manage participants’ use of medical specialist and inpatient care. Admit participants to the hospital, provide primary care or coordination of care with hospitalists, remain responsible for medical management, and provide updates to interdisciplinary team. In conjunction with the interdisciplinary team, plan, and coordinate discharge.
• Participate in planning and budgeting for the Medical Services
• Comply with all state and/or federal regulations to ensure the needs of each participant is met across all care settings 24-hours a day, every day of the year.
• Comply with all state and/or federal regulations to ensure reasonable and timely access to specialists as indicated by participant’s health conditions and consistent with current clinical practice guidelines.
• Comply with all state and/or federal regulations to ensure provision of services are documented, tracked, and monitored across all care settings.
• Comply with all state and/or federal regulations to ensure oversight of participants’ use of medical specialists and/or inpatient care.
• Comply with all state and/or federal regulations to ensure required assessments are conducted in response to each service determination request.
• Comply with all state and/or federal regulations to ensure the organization is performing assessments, collecting and analyzing the data from these assessments to take actions to improve the quality of the participant’s life.
• Comply with all state and/or federal regulations to ensure the IDT is conducting unscheduled reassessments as required.
• Comply with all state and/or federal regulations to ensure orders are based on the participant’s current needs and/or clinical practice guidelines.
• Comply with all state and/or federal regulations to ensure the IDT coordinates 24-hour care delivery that meets the needs of each participant across all care settings.
• Comply with all state and federal regulations to ensure that all ordered, approved, or care planned services are provided to the participant.
• Comply with all state and/or federal regulations to ensure all complaints regarding quality of care or service delivery are properly processed as a grievance.
• Comply with all state and/or federal regulations to ensure all individual issues within a grievance are reviewed, considered, and resolved.
• Comply with all state and/or federal regulations to ensure immediately approved SDRs have notification of the approval during the same encounter and/or interaction.
• Comply with all state and/or federal regulations to ensure all participant medical records are complete, accurate and accessible to all staff.
• Act only within the scope of practice.

Qualifications and Requirements:

Education/Training/Certifications:

• Successfully completed a residency program accredited by the Accreditation Council for Graduate Medical Education
• MD or DO designation
• Board Certification – Internal Medicine or Family Practice
• Board Certification – Geriatrics preferred
• Current [State] physician license
• Current BCLS
• State CDS Certification and DEA Registration
• Current driver’s license and proof of auto insurance

Experience: Minimum of 2 years experience working with a frail or elderly population. Minimum of 2 years experience managing, training, and providing oversight to other advanced care practitioners. Prior PACE and/or value-based care experience preferred.

Skills and Knowledge:

1.Clinical skills:

Detailed knowledge of physical and behavioral disorders common to participants in the PACE population. Recognition, diagnosis, treatment, and complete documentation of diagnostic and therapeutic interventions within the culture of the PACE model, as well as a comfort level recognizing patterns of functional decline, allowing for modification of participant/ caregiver goals of care and transition to palliative care, as necessary.

2. Strategic thinking

Care management, encompassing mitigation of high-cost care events and use of remote technologies and data as tools for clinical decision support.

3. Support skills, including

(a) collaboration and communication with participants, family/caregivers, IDT members, contracted facilities, and vendors to support care and (b) an understanding of social determinants that affect participants’ environments, level of treatment adherence, and the potential for success of recommended interventions

• Current knowledge of chronic care/geriatric issues and best practices.
• Ability to build strong working relationships with other physicians and other health care managers and providers.
• Good judgment, problem solving and cognitive skills
• Ability to process information accurately and timely
• Effective oral communication skills
• Strong organizational skills.
• Demonstrated leadership abilities
• Ability to lead and work within an interdisciplinary setting.
• Enthusiasm for geriatric medicine and taking care of the chronically ill
• Ability to anticipate and manage changing priorities.
• Legible handwriting
• Skill and knowledge of how to work effectively in a managed care environment.
• Working knowledge of PACE regulations.

We are an equal opportunity employer.

We do not discriminate on the basis of race, color, religion, marital status, age, national origin, disability, pregnancy, genetic information, gender, sexual orientation, veteran status, or any other status protected under federal, state, or local law.

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