Physician Assistant - Charleston, WV

Job Summary

The Well Be care model is a Physician Led Advanced Practicecliniciandriven geriatric care (care of older adults) team focused on the care of the frail, poly-chronic, elderly Medicare Advantage patients. This population is typically underserved and very challenged with access to care. To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care.

Care is provided throughout the entire continuum of care – from chronic care and urgent care in the home, to hospital, to skilled nursing facility, to assisted living, to palliative care, to end of life care. Well Be's physician/advanced practicing clinician led geriatric care teams’ partner with the patient’s primary care physician to provide concierge level geriatric medical care and social support in the home as well as delivering and coordinating across the entire care continuum.

The Physician Assistant is responsible for modeling the Well Be values and mission in the care delivery for our patients. S/he is responsible for following the rules and regulations of state and federal regulatory agencies and any other certified agencies for their region. As an advanced practice provider at Well Be, you will play a vital role in the care for our patients in their home.

This role is critical to our overall interdisciplinary team and focuses on providing compassionate care to the patients who have both chronic and acute illnesses and injuries while supporting their ability to stay in their own home. Our providers support a full patient panel and deliver longitudinal primary care, urgent care and acute medical care to a wide variety of patients.

This role delivers primarily home-based setting care for their patients. The Physician Assistant role is a key member of the team that will be accountable for the care of their patient panel, maintaining accurate, timely and current patient records, and will as part of our longitudinal model will support assuring patients are followed regularly with initial, urgent, transition of care and follow up appointments as needed to care for their health needs.

The successful candidate works as part of our broader interdisciplinary team to assist in delivering concierge-style, timely and high-quality care to every patient.

• Practices the Well Be mission:
  To help our patients lead healthier, meaningful lives by delivering the most Complete Care™ to their patient panel.
• Will primarily support in- home, patient-facing visits to support patient care needs in the market.
• Partners with other clinicians in the Care Community managing the health and wellbeing of patients living in their homes.
• Responsible for engaging attributed patients into Well Be program and supporting care needs and efforts to keep patients engaged.
• Facilitates staff, patient, and family decision-making by providing educational resources.
• Performs initial patient screenings/physical examinations, creates appropriate assessment/plan and completes documentation in a timely manner.
• Addresses urgent care needs of the patients as needed, including transition of care visits.
• Collaborates with community team to complete a full patient care assessment and plan.
• Orders, interprets, and analyzes diagnostic tests and determine the need for follow-up. appointments and further treatment options per state supervisory agreement.
• Prescribes and manage medications and treatments as appropriate, including but not limited to as psychopharmacological agents per state supervisory agreement.
• Updates patient records and check records for accuracy at each patient appointment.
• Delivers patient care and completes regular patient reviews with supervising physician per state supervisory agreement.
• Delivers the highest standard of quality care while maintaining all company metrics pertaining to appropriate patient needs.
• Focuses clinical care delivery to support necessary items for documentation/coding, HEDIS measures, engagement of patients, and managing medical expenses.
• Serves as a key resource for patients in delivering ongoing care information, counseling and guidance for any patients with critical…