Physician - Physician Network

Provide direct patient care in a Patient Centered Medical Home model, delivering well care and team-centered management of chronic disease states; interact with patients and families to inform and engage in decisions; counsel on wellness, prevention, and health maintenance; refer to specialty care as appropriate; use disease registries to identify gaps and coordinate with care managers to improve healthcare metrics; participate in process improvements to improve access (same-day appointments, extended hours) and ensure accurate documentation compliant with coding guidelines, CMS, HIPAA; collaborate with care teams and participate in transitioning care to specialists and inpatient services; maintain fiscal responsibility and contribute to value-based care; bilingual Spanish skills preferred. Education and licensure requirements include MD/DO, board certification or eligibility, active state medical license, and BLS, with Fingerprint Clearance Card as required.