Physician Leader, Patient Centered Medical Home Transformation
OakCare Medical Group - Oakland, CA

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OakCare Medical Group

Alameda Health System (AHS) consists of one acute hospital (Highland) with onsite generalist and specialist clinics and additional rehabilitation (Fairmont) and psychiatric (John George) hospitals as well as three free-standing clinics (Eastmont, Winton, Newark) in Alameda County. The ambulatory sites also include the Adult Medicine (K-6) Clinic and the Medical Specialty Clinics (H-4, K-7, and HCP clinic sites). The Department of Medicine includes 40 full-time faculty and 20 additional part-time faculty as well as 62 residents (categorical, primary care, and preliminary). The Department of Ambulatory and Preventive Medicine includes xx providers, including Physicians, Nurse Practitioners and Physician Assistants, who provide care in our Primary Care clinics.

The Patient Centered Medical Home (PCMH) transformation reflects an enterprise-wide reorientation of efforts and services to optimize and coordinate medical care for patients and families seeking services, focusing on the primary care clinics but extending its impact among specialty clinics (Medicine and Surgery and Maternal & Child Health).
OakCare Medical Group, a primary contractor for Alameda Health System, is seeking an energetic full-time Patient Centered Medical Home physician leader.

·Valid California medical license and DEA license
·Board certification (or pending certification after ABIM exam completion) in Internal Medicine or ·Family Medicine with credentialing suitable for Medical Staff appointment at AHS
·Strong interest/desire to work in a safety-net facility in a resource-limited area providing care for the underserved

Preferred: Experience in patient-centered medical home initiatives, project management, and/or quality improvement efforts (short- and long-term multidisciplinary projects) for clinical process enhancement and improved patient outcomes

Desirable: fluency in written and spoken languages other than English, reflecting our diverse patient population (e.g., Spanish, Cantonese)


·Serves as overall medical director of the PCMH transformation for AHS

·Works closely, collaboratively, and effectively with the Medical Home Manager to plan, implement, manage, and evaluate the relevant steps for transformation at all ambulatory (outpatient) sites

·Co-Chairs the PCMH Transformation Steering Committee and the PCMH Transformation Leadership Committee

·Reports regularly to the Chief Medical Officer (CMO) to ensure alignment of the strategic direction and concordance with other relevant initiatives and resource demands at the institutional level

·Prepares periodic reports for the CMO, Chief Executive Officer (CEO), and the Board of Trustees (BoT) to foster awareness, alignment, and reinforcement for the goals, methods, priorities, and results achieved to date

·Works with the Medical Home Manager through the PCMH Transformation Steering Committee and Transformation Leadership Committee to facilitate guidance, set strategic direction, and meet expectations of deliverables, timeline, budget and clinical outcomes

·Allocates and prioritizes resources as needed

·Facilitates both preparatory (job descriptions, training, protocol development, project planning) and executive (project management, process and outcome tracking) phases, working closely with the Medical Home Manager

·Participates actively and constructively in assigned committee work

·Provides substantive and effective participation in departmental and institutional initiatives and quality improvements, including efforts at optimizing provider, staff, and patient satisfaction

·Plans, implements, and evaluates the training and education of all relevant providers in the goals, operations, and potential impact of PCMH transformation of the institution

·Participates in implementing best practices, using clinical pathways and protocols via simplification, standardization, and thoughtful use of technology

·Demonstrate consistent, good citizenship and professionalism in daily work and assigned tasks, both as an individual and within working groups

·Provides direct clinical care and supervising of medical residents and other health professionals three half-days per week

·Provides clinical assessment, diagnostic determination, ongoing clinical management, necessary referral for consultation, care planning, therapeutic orders, transfer authorization, risk assessment, and determination as appropriate for admission or transfer of patients, both directly and via supervision of trainees in ambulatory settings

·Provides patient contact and care management that actively encourages and includes professional input from all members of the patient care team

·Performs review of resident evaluation and notes for format, relevance, and accuracy with correction as needed, including completeness of dates, times, and legible signatures, ensuring timely completion of all professional records and documentation in compliance with local, state, and federal regulatory, licensure and accreditation requirements

·Completes all medical record documentation and billing submissions within one business day of service

·Provides prompt, effective, and efficient cross-cover of residents to allow them to attend scheduled educational sessions as well as role-modeling of handoffs to other health professionals as needed

·Provides direct contact and consultation with patient’s family members, friends, advocates, and relevant others to ensure effective communication of patient status and care plans and to encourage and support a patient-centered and family-friendly style within the institutional environment

·Performs in a manner to create and sustain a positive work culture with cross-department collaboration and in alignment with other Alameda Health System initiatives

·Perform other related duties incidental to the work described above

·Provides evaluation of trainees with explicit formative feedback on knowledge, skills, attitude and overall performance at least twice annually

·Fosters self-directed learning by all trainees and sharing new knowledge with the team

·Contribute evidence-based presentations for noon conferences, ideally interactively, at least semi-annually

·Attend and actively participate at most weekly Medicine Grand Rounds

·Conduct interviews of prospective resident candidates and potential faculty candidates

·Serve as a professional role-model for trainees in interactions with peers, patients, families, and other members of the health care team

Competitive salary and extensive benefits package including Earned Time Off, group insurance, short and long term disability, long-term care, 401k plan with generous employer match, business-related and Continuing Medical related expenses and more.