CAHM Complex Care - Internal Medicine, Geriatrics - M89946

The VCU Health Center for Advanced Health Management (CAHM) is a multi-faceted care system including: office-based medical care for those who are comparatively mobile; home-based care both short-term and long-term for those that are less mobile; short and long term nursing home care; inpatient consult service at VCU Medical Center; behavioral health treatment and counseling on-site; pharmacy consultation on-site; robust care management and social work services integrated with the medical team; developing telemedicine services (triage, counseling, monitoring, video-visits). CAHM opened in 2014, and is modeled to perform optimally in the burgeoning outcomes-focused, performance-driven reimbursement environment.  High-risk beneficiaries are targeted for assignment to CAHM based on multi-faceted complex needs and are supported holistically using a comprehensive continuum of services that VCU owns or organizes. Providers work in teams and patient volumes and work flows are decreased from typical standards in recognition of the complex nature of the patient population, and the increased effort and time required to manage to outcomes now expected by payers and patients, alike. 

1. →Teaching: To support teaching directly via interactions with fellows, residents, medical students, and non-physician professionals. (Affiliate faculty appointment)
2. →Research: To support the research mission of the Division. 
3. →Service: To provide service of the highest quality to the people of the state of Virginia and beyond.
4. →Clinical:  Anticipated clinical effort is 100%.  The workload and time commitments are commensurate with existing Geriatric Division faculty.
   • →To be responsible for managing a panel of patients in the VCU Center for Advanced Health Management’s complex care clinic, an advanced health home for the chronically-ill, multi-morbid, often behaviorally & socially challenged population. 
   • →To assure that care is timely, appropriate, of high quality, and cost effective.
   • →To create and enhance systems to assure that all patients receive planned, evidence-based care and care is fully coordinated with ongoing continuity for the patient, family and caregiver.
   • →To work collaboratively with attending physicians, fellows, residents, nurse practitioners, and other staff to ensure a team-based approach to care is fostered.  
   • →To understand and welcome the importance of roles as care providers, team members, and major influencers of our community’s perception of the medical home’s quality and service. Sharing telephonic night call (one in ten currently).

1. →Other: (administrative duties, etc.) Submit billing and document care as required by the organization. Abide by all medical staff requirements.  Participate in quality initiatives.

Minimum Qualifications

• Board Certified /Board Eligible in Internal Medicine or Family Medicine
• Must be comfortable working with an interdisciplinary team including nurse practitioners and pharmacists, and must integrate well with members of an extended care team. 
• Must have direct experience managing complex outpatients with a solid understanding of the comprehensive primary care role and function.
• Demonstrated ability to work in and foster an environment of respect, professionalism and civility with a population of faculty, staff, and students from all backgrounds and experiences, or a commitment to do so as a faculty member at VCU.

Preferred Qualifications

• Experience with EPIC  electronic health record preferred.

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