Independently provides care for patients with acute and chronic illnesses encountered in older adult patients.
Takes full accountability for patient care and outcomes and appropriately seeks consultation from specialists when needed, while remaining involved in the detailed care of the patient.
Engages with the hospitalist whenever one of their patients is in hospital (regardless of whether the hospitalist works for ChenMed or not).
Responsible for assessment, diagnosis, treatment, management, education, health promotion, care coordination and documentation for patients with acute and complex chronic health needs.
Leads their care team consisting of a care promoter (medical assistant), care facilitator and care coordinator for patients able to come to the office.
For patients unable to come to the office – in hospital, SNF, LTC or homebound – engages with the transitional care team and ot...