PACE Medical Director - PACE

Job Summary:

The Medical Director for PACE (Programs of All-Inclusive Care for the Elderly) leads the medical oversight and direction of care for PACE participants. This role is pivotal in ensuring the delivery of high-quality medical services, improving clinical outcomes, and developing medical policies and procedures. The Medical Director collaborates with primary care physicians, nurse practitioners, physician assistants, nursing staff, and allied health professionals to uphold the PACE philosophy and model of care. As a member of the leadership team, the Medical Director represents the PACE Program within the community.

Essential Duties and Responsibilities:

Quality & Compliance

1. Actively participate in the Quality Improvement Committee, providing guidance on quality improvement initiatives and plans alongside the Quality Team.
2. Collaborate with the Quality Improvement Coordinator to develop, implement, and monitor outcome measurements for efficient healthcare service utilization, including:
• Hospital and emergency room admissions
• Pharmaceutical management
• Specialist referrals
• Medication management
• Nursing facility admissions
3. Ensure optimal healthcare service utilization by identifying best practices and working with clinical staff and the Interdisciplinary Team to make informed clinical and operational decisions.
4. Review medical records to evaluate participant care and ensure adherence to established protocols.
5. Ensure compliance with the PACE Program’s Part D Fraud, Waste, and Abuse Compliance Program.
6. Hold overall accountability for the medical care provided to participants and guide the Clinical Team in achieving quality and outcome goals.

Operations/Leadership

1. Support primary care providers and serve as interim coverage until additional staff can be hired as needed.
2. Collaborate with the executive management team on internal operations, program development, and resource allocation.
3. Engage in planning and budgeting processes, reviewing financial and utilization reports.
4. Conduct competency evaluations for primary care staff.
5. Participate in the annual performance evaluation of primary care physicians and nurse practitioners.
6. Engage with the National PACE Association Physician Network to ensure representation and recognition.
7. Report directly to the PACE Executive Director.

Primary Care/Clinical

1. Supervise PACE primary care practitioners, including physicians, nurse practitioners, and physician assistants.
2. When acting as the Primary Care Physician:
• Attend and participate in daily Interdisciplinary Team meetings.
• Communicate changes in participant status effectively.
• Collaborate on care planning decisions.
• Ensure coordination of 24-hour care delivery.
• Provide primary care and assessments for participants across various settings.
• Evaluate and treat participants during acute illnesses.
• Oversee the management of specialist consultations and inpatient care.
• Rounding with contracted Nursing Homes.
• Facilitate hospital admissions and ensure continuity of care with hospital staff.
• Collaborate with the Interdisciplinary Team for discharge planning.
3. Oversee the development of clinical standards and uniform treatment policies that align with PACE values.
4. Integrate medical services with other care services to provide a seamless continuum of care for participants.
5. Offer consultative support to primary care providers in all settings.
6. Discuss clinical and case management issues with primary care staff and medical consultants.
7. Monitor clinic operations to ensure integration of primary care and nursing services.
8. Collaborate with PACE contracted providers on diagnostic coding practices and documentation.
9. Participate in primary care, hospital, and nursing home rounds, and maintain a 24-hour on-call system to assure continuity of care.

Qualifications:

1. Education:
• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
2. Credentials/Licensure:
• Valid medical license in the State of Delaware.
• Board-certified in Internal Medicine or Family Practice.
• Board certification in Geriatrics preferred or a Certificate of Added Qualifications (CAQ) in Geriatrics.
3. Experience:
• Minimum of five years of clinical experience, with a preference for geriatrics.
• At least two years in a Medical Director or equivalent administrative role.
• Experience working within an Interdisciplinary Team.
• Managed care experience preferred.
4. Special Training:
• Knowledge of the PACE model of care delivery.
• Commitment to the Preventative Model of Care for the Elderly.
5. Patient Population:
• Experience with adult and geriatric patient populations.

Knowledge and Skills:

1.      Clinical and Administrative Leadership: Demonstrated ability to lead both clinical and administrative teams effectively.

2.      PACE Care Management: Strong understanding of the PACE model and its medical management processes.

3.      Regulatory Knowledge: In-depth knowledge of state and federal regulations governing the PACE Program.

4.      Technology Proficiency: Familiarity with automation and information technology management systems, with a basic understanding of their applications in healthcare.

5.      Electronic Medical Records (EMR): Proficient in using EMR systems, with the ability to accurately document care planning, assessments, and progress notes.

6.      Team Collaboration: Strong ability to coordinate and collaborate within a multidisciplinary team environment.

7.      Advocacy for Elderly Care: Committed to acting as an advocate for frail elderly participants and addressing their unique needs.

8.      Customer Service Excellence: Dedicated to providing and promoting exceptional customer service to all participants.

9.      Autonomous Decision-Making: Capable of making independent clinical and management decisions while maintaining high standards of care.

This role requires a dynamic leader committed to enhancing the quality of care for elderly participants while collaborating effectively with a diverse team of healthcare professionals.