Primary Care Physician

Family Nurse Practitioner 

Full Job Description

Community Bridges, Inc. (CBI) is an integrated behavioral healthcare agency offering a variety of different programs throughout Arizona. CBI provides residential, outpatient, inpatient, patient-centered medical homes, medication-assisted treatment, and crisis services to individuals experiencing crisis, opioid use disorder, homelessness, and mental illness.

At Community Bridges an addiction practitioner is an integral specialty for our whole person appropriate of our integrated system of physical, and addiction services CBI provides. The scope of practice of addiction practitioners in the outpatient setting will see adults 18 and older, all genders, all socio-economic backgrounds, complex medical history, and co-occurring addiction disorders.  The addiction practitioner may see patients under the age of 18 based on program assignment.  Addiction practitioners at CBI will be expected to provide patient-centered, evidence-based care for patients as well as serve as patient advocates in all health-related matters, including the appropriate use of specialists, health services, and community resources.

This document defines the skills, activities, and expertise that fall within the psychiatric practitioner’s scope of practice in the inpatient and outpatient setting.
General scope within their skills, competencies, and experience, licensed practitioner shall:

• Complete a comprehensive addiction assessment addressing the six assessment dimensions of the current ASAM Patient Placement Criteria (PPC) to make an appropriate diagnosis of all substance use disorders present.
• Assessment and treatment may be performed in either the inpatient detox setting or addiction inpatient detox setting.
• Complete a history and physical on all new patients admitted at the time of the provider is rounding
• Perform a physical examination to evaluate the patient’s general health status with special attention to physical manifestations of substance use disorders, including intoxication and withdrawal and co-morbid medical conditions.
• Perform a mental status exam and collect a addiction review of systems to rule out or rule in the presence of significant co-morbid addiction conditions that should be addressed along the individual's substance use disorder; this includes risk management assessment of self-harm, suicide, and harm-to-other risk.
• Monitor and lead a multidisciplinary clinical team offering patient care that is safe, effective, compassionate, and appropriate within a structured program of psychosocial treatment, psycho-educational experiences, and pharmacotherapy services
• Integrate other sources of data into diagnostic assessment, medical records, and interviews of family members and other relevant collaterals to confirm or refute patient self-reports and come to the most accurate diagnosis and treatment plan.
• Assess and develop a treatment plan to medically manage withdrawal from alcohol and other drugs, appropriate to the level of care provided, or refer for a higher level of care if indicated by appropriately using and interpreting standard withdrawal assessment scales.
• Form relationships with the patient that includes unconditional acceptance of the patient, regardless of the severity of his or her primary disease or its complications, and which may include the patient’s inability to adhere to recommendations regarding abstinence from alcohol or drug use.
• Initiate, continue, and discontinue addiction pharmacotherapies, as indicated, as a component of general Addiction Medicine services.
• Identify proper patient candidates for office-based opioid treatment, to perform outpatient inductions for MAT appropriately as an opioid withdrawal management medication and refer for outpatient management as appropriate upon discharge.
• Develop and execute written treatment plans during inpatient course, to participate in multidisciplinary team review of treatment plans and discharge plans.
• Appropriately consult physicians from other specialties and other health care professionals as indicated during inpatient stay.
• Providers are to coordinates with the care team to provide care/treatment planning.
• Maintain appropriate medical records of physician/practitioner services provided to patients and family members when offering inpatient Addiction Medicine services.
• Make informed post-treatment referrals of patients with a variety of substance use disorders and complicated co-occurring disorders (addiction, addiction, and medical problems).
• Use AZCSPMP electronic prescription drug monitoring program databases to verify the patient's substance use history during the history-taking process and as required by state and federal regulations.
• Assess patients with chronic non-cancer pain who are using opioid analgesics, and assist in their care, consider referral to Unscript making an appropriate assessment for the presence/absence of co-morbid addiction along with their underlying pain medicine condition; and demonstrate the ability to consult bi-directionally with pain medicine physicians and pain clinics.
• Manage special populations, pregnant women determine appropriateness for inpatient therapy, utilizing gender specific primary treatment and continuity of care.
• Work collaboratively with the CBI Care Team in reviewing continuing care and discharge criteria per the ASAM PPC recommend appropriate plans for addiction care.
• Recognize and treat substance use conditions (e.g. intoxication, withdrawal, use disorders) in the setting of acute and chronic medical conditions.
• In pregnant women manage withdrawal from alcohol, sedatives, and opioids, in consultation with a maternal fetal medicine specialist.  Manage addiction to alcohol and other drugs in women, making appropriate adjustments to pharmacotherapy choice and dosing during pregnancy, and utilizing gender-specific primary treatment and continuing care as indicated.
• Coordinate care with the primary care practitioner and any other outpatient medical practitioner providing care to the patient.

Medical knowledge:

• Demonstrate understanding of the diagnostic criteria for substance use disorders and various intoxication and withdrawal states, per the most recent edition of the DSM
• Demonstrate understanding of the pharmacology of pharmacotherapeutic agents for alcohol, nicotine, and opioid addiction, proper dosing, and ongoing management using them
• Demonstrate understanding of the pharmacology of pharmacotherapeutic agents for alcohol and other drug withdrawal management
• Demonstrate knowledge of the theory and practice of office based opioid treatment using buprenorphine and how to integrate that into outpatient treatment of addiction
• Demonstrate knowledge of the levels of care for addiction treatment in the ASAM Patient Placement Criteria and which level to recommend based on patient need and motivational level
• Demonstrate understanding of the multiple pain syndromes including neuropathic pain, and how to differentiate addiction and pseudo-addiction in patients with chronic non-cancer pain
• Demonstrate understanding of how to classify patients according to level of motivation and stage of change
• Demonstrate knowledge of the scope of substance use during pregnancy: tobacco, alcohol, opioids and opiates, stimulants, sedatives and hallucinogens and demonstrate knowledge of the effects of drugs on the fetus
• Demonstrate knowledge of the special risks of intoxication and withdrawal in the pregnant patient, including seizure, placental abruption, fetal distress and fetal death

Universal:

• Complete orientation as directed by CBI, which includes shadowing another CBI practitioner prior to working with patients
• Complete a TB skin test prior to working with CBI patients and annually thereafter TB skin test prior to working with CBI patients and annually thereafter to ensure professional is free from tuberculosis. Test results must be submitted to the Credentialing department annually.
• Obtains and maintains suboxone waiver for to treat the maximum number of patients for which the practitioner is eligible.
• Maintains necessary patient data logs as required when treating patients with buprenorphine to coordinate with the medical practice team and clinical team on caseload size.
• Provides evidence of CPR/First Aid prior to working with CBI patients and provides documentation of renewal every two years. Evidence of CPR/First Aid renewals must be submitted to the Credentialing department.
• Participate in quality management initiatives and correct any identified areas of deficiency within 72 hours; exceptions must be approved by the Director of Medical Practice in consultation with the CBI Medical Director.
• Maintain a minimum 85% compliance with documentation requirements
• Not cancel patient appointments without prior notification to CBI
• Not refuse to see CBI patient(s) without approval from the medical director
• Adhere to the appointment scheduling protocols assigned by the medical director and monitored by the medical management team.
• Maintain a minimum 85% patient satisfaction. If performance falls below 85%, practitioner will submit a plan of correction to the Medical Director.  If performance falls below 85% for two consecutive months, practitioner will be removed from the schedule and will not receive compensation during this time.
• Maintain a minimum of 75% follow-up rate
• Complete and document all medication assessments and informed consents by the end of assigned shift or within 24 hours of seeing the patient.
• Review the Controlled Substance Prescription Monitoring Program prior to treatment and coordinate care with other prescribing practitioners
• Utilize e-Prescribing for all patient prescriptions as established in the CBI electronic medical record
• Attend regular staffing and rounds on assigned patients; participate in the development of the patient’s treatment plan; provide clinical expertise for the treatment team for patient care; give appropriate direction and providing effective communication about patient care activities
• Support utilization review activities by clearly documenting admission medical necessity and continued stay necessity. This includes completion of certification of need for Level I admissions or facilitating completion by a physician if the practitioner is a Nurse Practitioner or Physician Assistant
• Support utilization management activities by providing reviews when requested by payors
• Ensure necessary documentation and treatment for patients under petition or court order
• Promote collaboration patient care by communicating with referring and receiving professionals
• Attend and actively participate in practitioner meetings; actively participate in any state, regulatory, or accreditation surveys; participate in peer review activities and performance improvement projects
• Comply with agreed upon work schedules to provide coverage at the facility and meet the clinical and business needs.  CBI maintains the right to schedule Medical Professional at any facility and will make every attempt to establish routine schedules.
• Give a minimum of 60 days’ notice for time off and will coordinate with peers to arrange for coverage for scheduled shifts. Time off requests will be sent to medicaltimeoff@cbridges.com and if employee, will also submit request into CBI’s current time and attendance system
• Notify Director of Medical Practice and Medical Director in the case of an emergency and inability to cover a scheduled shift
• Adhere to all policies and procedures established by CBI
• Other duties as assigned

Documentation:

Medical Professionals are expected to complete documentation within 24 hours of visit. Should documentation not be complete by allotted timeframe, Medical Professional must notify the Director of Medical Practice.

Training:

Medical Professionals may be asked to have new clinical staff of the same specialty or experience shadow them or be trained by them. Should the training impact patient care, adjustments will be made to practitioner schedules during training hours.

Practitioner Education:

Medical Professionals will be expected to attend educational meetings as deemed appropriate for their specialty. Medical Professionals will be expected to attend quarterly practitioner meetings. Should Medical Professional be unable to attend these meetings, a 24-hour notice will need to be given to the Director of Medical Practice.  Should an unexpected event occur, and the Medical Professional is unable to give notice. they will be expected to contact the Director of Medical Practice as soon as possible. Minimum of 3 quarterly meeting required per year.

Integration:

As Medical Professionals, it is important to recognize practice limitations and seek consultation with other healthcare professionals, when necessary, to provide optimal patient care. CBI offers behavioral health services, physical health services, and psychiatric medicine services, as well as partnerships outside of the agency. Medical Professionals are encouraged to utilize this care integration model to optimize patient care.

CBI Offers an excellent benefits package!

• Medical, Dental, Vision, Disability, Life, Supplemental plans - Hospital indemnity/ Critical Illness, Pet Insurance, Dependent Care Savings, Health Care Savings, 401K with employer match - 100% vested upon enrollment, Generous PTO accrual, Wellness programs, Tuition Reimbursement and Scholarship Programs, incentives, and more!
• For the past four years, The Phoenix Business Journal has recognized CBI as one of the top ten healthiest mid-size employers in the Valley.

CBI treats patients from all different walks of life and believes in maintaining the dignity of human life. Recovery is possible!