Physical Demands and Working Conditions:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. In compliance with ADA requirements, reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Work Environment:

Employee must be able to work effectively within an interdisciplinary team model, interfacing and collaborating with a wide range of clinical and social services disciplines who work together to manage the PACE participants’ care. The work setting is in an Adult Day Health Center and primary care clinic environment with moderate noise levels and controlled temperatures.

Physical Requirements:

Requires manual and finger dexterity and eye-hand coordination; the ability to use department equipment; and the ability to lift/carry up to 30 pounds using appropriate body mechanics with reasonable accommodation if needed.

Visual, Hearing and Communication Requirements:

Requires corrected vision and hearing to normal range, with or without reasonable accommodation. Ability to communicate by way of the telephone with participants, customers, vendors and staff.

Pressure Factor:

Requires working under stressful conditions. Working conditions may be noisy and crowded and fluctuating indoor temperatures. Moderate pressure to meet scheduled deadlines. Potential for exposure to verbal aggression by client, vendors, and staff.

Environmental Conditions:

May be exposed to a risk of bodily injury through contact with moving instrumentation, toxic substances, medicinal preparations, bodily fluids, communicable diseases and any other conditions common in a healthcare environment. Subject to unpleasant odors.

Duties and Responsibilities:

• Provide primary medical care preventative and acute, evaluate healthcare complaints or caregiver concerns and provide appropriate treatment.
• Perform in-person comprehensive history and physical on new PACE participants and reassessments both scheduled and unscheduled. 
• Educate participants, their caregivers, family members and/or designated representatives regarding specific medical conditions and care.
• Participate in the collaborative development and implementation of the participant plan of care.
• Maintain regular attendance at the daily Interdisciplinary Team meeting communicate participant changes, updates to inpatient care, recommendations for new clinical interventions, and coordination of 24-hour care delivery.
• Admit and provide primary care (attending) responsibilities for medical management in hospital or direct and coordinate care with Hospitalists. Provide regular updates to Interdisciplinary team. In conjunction with the interdisciplinary team, plan and coordinate discharge for acute, short-term and long-term placement.
• Provide care in the most appropriate setting including participants’ homes.
• Refer participants to medical specialist if indicated, follow up with specialists regarding outcome of visit, and authorize additional specialist follow up care if needed. 
• Manage all care of participants in the nursing home. Provide regular visits as dictated by [PACE Organization]’s standards and participant’s need. Make telephone contact with nursing home staff as required or needed. Admit nursing home participants to hospital when necessary.
• Participate in rotating night and weekend call.
• At the direction of the Medical Director, review medical outcomes/statistical and utilization data, including review of necessity of ER visits, hospitalizations, and use of specialists. When problems are identified, work with the Medical Director to establish best practices and with clinical staff and interdisciplinary team to make appropriate procedural and or operational changes to avoid unnecessary or avoidable ER visits or hospitalizations.
• Complete accurate documentation of all diagnostic codes for each participant.
• Complete participant care documentation with accuracy and timely in compliance with the program’s documentation policy. 
• Advise the Medical Director in ways and means to establish better accountability of PACE services to participants and referral sources.
• Keep the Medical Director informed of needed material and human resources as program expands. 
• Assist with the development of policies and procedure, standards of care and perform on-going monitoring and evaluation of patient care practice and service delivery.
• Provide guidance and training to staff regarding medical and quality assurance issues. 
• Protect privacy and maintain confidentiality of all company procedures and information about employees, participants and families. 
• Follow all Policies and Procedures and OSHA safety guidelines.
• Participate in continuing education classes and any required staff and training meetings.
• Maintain professional licensure and certifications.
• Provide information about [PACE Organization] to interested individuals and groups.
• Participate in and support Quality Improvement initiatives.
• Act only within the scope of his or her authority to practice.
• Perform other duties as required or requested.