Lead Physician Value Based Care

Job Description:

The Cityblock (CBH) Provider Lead serves as a practice-based provider, supporting members with scheduled appointments, walk-ins and urgent or emergent visits across multiple modalities (telephonically, virtually, or hub (clinic) setting). The Provider Lead delivers comprehensive clinical management, chronic disease management, behavioral health condition management (i.e. depression, anxiety, substance use disorder), and preventative care and wellness support.

The role works collaboratively with an interdisciplinary team of clinical and non-clinical members to develop member care plans and to support members throughout their care journey. The Provider Lead also assists with the development and enhancement of clinical programs, initiatives, processes, and policies. They oversee the care for the most complex patients in their market. They are the day to day point of contact for escalation for complex cases and ensure high quality, comprehensive and safe care is provided by their direct reports.

This is a Hybrid role: 3 days on-site at Cincinnati Hub (clinic) 2 days virtual

Responsibilities:

Clinical Visits

• Conduct comprehensive clinical intake visits for selected members (based on member segmentation, program empanelment and care team recommendation).
• Conduct timely follow-up for members post transition of care event, acute need or according to condition-specific needs.
• Proactively outreach to members who need follow up care.
• Provide clinical care in line with CBH protocols.
• Complete comprehensive and compliant diagnosis capture related to HCC (Hierarchical Condition Categories) and ICD-10 (International Classification of Diseases-10) Coding.
• Address contractual and company-prioritized quality gaps and ensure proper chart documentation and codes (ICD or CPT) are included in the encounter as supporting evidence of gap closure.
• Address and respond to member needs and delegate tasks in a timely fashion.
• Finish documentation and hold direct reports accountable to company policy.: sign and complete notes within 48 hours of clinical encounter

Clinical Scope

• Prescribe 1st and 2nd line medications for depression, anxiety, alcohol use disorders and opioid use disorders.
• Continue psychiatric medications for members with stable Serious Mental Illness (SMI)
• Remain up to date on evidence-based care for complex patients in primary care. Provide longitudinal direct primary care and/or wrap-around care in accordance with the local contracts with focus on chronic condition management and preventative care.
• Refer members to specialist care appropriately and according to internal CBH guidance if available.
• Support the member in achieving the goals in their care plans (physical, behavioral, and/or social health).
• Case review and care planning
• Participate in case conferences with the care team, providing clinical expertise on care plan development.
• Provide guidance on highest impact clinical interventions and tasks to achieve a member’s goals.
• Supervise Advance Practice Providers within the market as needed in order to assure clinical quality and meet regulatory requirements.
• Panel management
• Collaborate on a panel of members to provide clinical input, including health maintenance, chronic disease management and co-occurring psychiatric disorder support
• Collaborate with care team to determine need for member placement in a different program (e.g., lower or higher intensity program)

Operations

• Ensure coverage and communication for out of office providers
• Utilize our care facilitation, electronic health record and scheduling platforms as needed to collect data, document member interactions, organize information, track tasks, and communicate with your team, members, and community resources

Leadership

• Provide clinical consultation for care team members including education on clinical issues, support with care plans and review of clinically concerning member conditions.
• Act as the collaborating physician for oversight of Advanced Practice Clinicians and complete chart reviews in compliance with CBH policy
• Guide clinical team on complex clinical cases. Be available for escalation questions at the point of care. Provide clinical consultation for care team members including information on clinical issues, support with care plans and review of clinically concerning member conditions
• Own clinical education curriculum, identify individual training needs and help provide resources to fill in the gaps
• Works in collaboration with: VP, Market Medical Practice, Associate Medical Director and market operations leaders.

Work Experience:

• 5+ years direct member care
• 2+ informal clinical leadership