Palliative Care Specialist - Houston, TX

Position: Palliative Care Physician

Monogram Health is seeking a full-time physician, specialized in palliative care, to join the team due to continued nationwide growth. This physician will be an in-market specialist and care for the seriously ill population in their community, including patients with CKD/ESRD, COPD, and CHF. The Palliative Care physician will be integrated into their local market with the pod Medical Director and primarily renders care in the home and through telemedicine visits.

Your Impact

Monogram Health physicians are quality-driven physicians who apply their clinical expertise in a managed care, population health context. They also engage in population health management in a sophisticated, outcomes-driven manner that promotes palliative care where clinically appropriate and focuses on patient quality of life, education, and shared-decision making.  

Highlights & Benefits

• Opportunity to work in a dynamic, fast-paced and innovative organization that is transforming the delivery of polychronic disease care
• Hybrid schedule with In-home, in-person, and travel opportunities
• Competitive salary plus company bonus program
• Full benefits including medical, dental, vision and life insurance
• Paid time off and 401(k) with matching contributions
• Relocation assistance and sign on bonus on case-by-case

Roles & Responsibilities

• Collaborate with market Medical Director and the care team to proactively identify patients who qualify for palliative care services and build a patient panel
• Developing and presenting metrics to executive leadership, as requested
• Responsible for the outcomes for patient panel, driving both predetermined clinical and financial Key Performance Indicators (KPIs) through interventions outlined below
• Treat panel of patients both in-home and virtually, as necessary, to drive healthcare outcomes
• Evaluate and treat symptoms that may interfere with quality of life, like pain, depression, anxiety, insomnia, etc.
• Refer members to appropriate specialists to drive clinical care (Monogram-based specialists or locally-aligned specialists)
• Conduct goals of care and family meetings as needed and document patient/family wishes in state AD/POLST forms
• Support patients utilizing our IDT, including Palliative Care Chaplain
• Assist with hospice transitions as appropriate
• Develop key relationships with local providers (PCP, nephrologists, specialists) to improve market alignment
• Participate in monthly meetings with RMD/CMO in areas of KPI and expectations around KPIs
• Educate and support team around palliative care, hospice care, advance directives, symptom assessment, and communication

Position Requirements

• Desire to practice in a forward-looking renal care environment focused on population health management
• Demonstrated experience applying evidence-based clinical criteria
• Comfort and skill in goals of care discussions and advance care planning
• Experience with high-need Medicare Advantage and managed Medicaid populations, as well as commercial populations
• Experience integrating acute and behavioral health care and appreciation of social determinants of health and the value of social workers
• Expertise in managing medication panels for complex patients
• Current state medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
• Willingness to become licensed in multiple states as company and patient needs require
• Doctorate Degree in Medicine
• Board Certified in Hospice and Palliative Medicine
• Must have reliable transportation

About Monogram Health

Monogram Health is a next-generation, value-based chronic condition risk provider serving patients living with chronic kidney and end-stage renal disease and their related metabolic disorders. Monogram seeks to fill systemic gaps and transform the way nephrology, primary care and chronic condition treatment are delivered. Monogram’s innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum. By focusing on increasing access to evidence-based care pathways and addressing social determinants of health, Monogram has emerged as an industry leader in championing greater health equity and improving health outcomes for individuals with chronic kidney and end-stage renal disease.

At Monogram Health we believe in fostering an inclusive environment in which employees feel encouraged to share their unique perspectives, leverage their strengths, and act authentically. We know that diverse teams are strong teams, and welcome those from all backgrounds and varying experiences.

Our name, Monogram, symbolizes the personalized focus of our services.

While the application of the latest technology and data science is critical to our success, we never lose sight that healthcare is ultimately about trusted individual relationships between healthcare professionals and their patients.

Unfortunately, individuals living with advanced CKD and ESRD are negatively impacted by well entrenched systematic forces such as perverse economic incentives, poor adherence to evidence-based care, and a lack of sensitivity to the negative impacts of social determinants of health.

The 21st Century Cures Act is a seminal piece of legislation designed to shift individuals living with ESRD from FFS Medicare into managed care and reverse decades and decades of sub-optimal outcomes. Monogram was born with a vision to serve health plans and other sponsors of health care and solve for these systemic problems.  Our mission is to improve clinical outcomes by predicting the onset of CKD and ESRD, slowing its progression, and reducing hospitalizations, morbidity and mortality.

We are founded and operated by a core group of former government programs health plan executives, including our CEO, Michael Uchrin, a world-renown nephrologist and author of over 200 published pieces of research, Dr. Raymond Hakim, and former US Senator Bill Frist M.D., a retired cardiac surgeon and recognized leader for improving the quality of care provided to human beings across the world.

We welcome all stakeholders in the CKD | ESRD ecosystem to join us in our mission to measurably improve outcomes for individuals living with these conditions.