Overview
Support the mission of People's Community Clinic by providing medical care and support to patients in a manner consistent with clinic values and standards; work with other employees to achieve high standards of operational efficiency and service effectiveness.
This position works as a member of a care team to coordinate patient care and support patients and families in self-management, self-efficacy, and behavior change. Care team members are expected to assess and manage the health needs of the patient population and to communicate effectively with all patients, especially vulnerable populations.
Location: 1101 Camino La Costa, Austin, Texas, 78752
Schedule:This is a full-time position, working 9 patient care clinics and 1 administrative clinic (approximately 4-hour blocks each)
Responsibilities
Under the supervision of the appropriate Medical Department Director as well as the supervising physician, this individual's primary responsibilities include:
Provide direct medical care for patients according to established standards of care, including:
Provide culturally competent care to a diverse and underserved patient population.
Provide comprehensive primary care services, including age-appropriate physical exam, history, detailed health risk screenings, medication review, immunizations, annual wellness visits, diagnosis, and management of acute and chronic medical conditions following clinic procedures and up-to-date standard of care.
Conduct comprehensive Medicare Annual Wellness Visits in a clinic, following CMS guidelines.
Identify preventive screening needs, chronic disease risks, and lifestyle improvement opportunities.
Develop personalized care and wellness plans in collaboration with patients and their primary care providers.
Document all encounters accurately in the EHR(e.g., Epic) and submit billing codes promptly to ensure compliance and continuity of care.
Educate patients on preventive services, vaccinations, and community resources.
Collaborate with care coordinators, RNs, and physicians to close care gaps and improve quality metrics.
Order, interpret, and follow up on diagnostic tests and labs.
Counsel patients regarding treatment plan, prescribed medications, general health and wellness, and management of diagnosed conditions.
Develop and implement individualized care plans in collaboration with patients and care teams, including nursing and other support staff, to coordinate team-based care of the patient.
Provide patients with telephone/video counseling for issues including but not limited to laboratory test results, follow-up treatment, and patient inquiries.
Make referrals to medical specialists, social services, and other services as indicated by presenting problems.
Provide any medically necessary follow-up on diagnosis, diagnostic evaluation, or treatment required for the patient's care.
Participate in the rotating provider on-call responsibility for urgent lab results and after-hours nurse triage service, which takes first calls from patients but may, in some cases, require provider backup.
Provide cross-coverage for the care of clinic patients when the patient's primary provider is not available (e.g., responding to lab results or phone messages when the primary provider is not available).
Communicate with and lead the interdisciplinary care team that will include medical assistants and nursing staff, as well as additional members such as community health workers, social workers, and our medical-legal team.
Maintain standards of proficiency, service quality, efficiency, and effectiveness in all task areas.
Participate in program planning, development, evaluation, and implementation activities:
Qualifications
Education:
Experience:
Knowledge, Skills, and Abilities:
Our Benefits Include:
People's Community Clinic is committed to equal employment opportunity regardless of race, color, national origin, religion, gender, sexual orientation, age, language, disability, pregnancy, gender identity, or sex stereotyping.