Job Description

Job Description

Job Description

Job description

We are seeking a mission-driven Telehealth Primary Care Physician to provide remote medical consultations and ongoing clinical support for patients across post-acute, long-term care, and complex care settings. This role focuses on proactive chronic disease management, timely intervention, care coordination, and reducing avoidable hospitalizations and readmissions.

The ideal candidate is comfortable practicing in a telemedicine environment, has strong clinical judgment, and is experienced in Transitional Care Management (TCM) .

• Provide remote patient consultations and follow-up care via telehealth

• Evaluate patients, develop treatment plans, and ensure timely clinical follow-up

• Perform Transitional Care Management (TCM) , including post-discharge follow-up, medication reconciliation, and coordination of care

• Manage chronic and complex medical conditions through evidence-based virtual care

• Collaborate with NPs/APPs, nursing staff, care coordinators, rehabilitation teams, and other providers

• Respond promptly to changes in patient condition and help prevent avoidable hospital transfers and readmissions

• Participate in interdisciplinary care planning and case review

• Discuss goals of care, preventive care, and palliative care options with patients and families as appropriate

• Maintain accurate, timely documentation in the EMR

• Support continuity of care through strong communication with patients, families, and clinical teams

• MD or DO from an accredited medical school

• Board Certified or Board Eligible in Internal Medicine, Family Medicine, or Geriatrics

• Active, unrestricted medical license in [State] or eligibility to obtain

• Current DEA registration, as applicable

• Experience with telehealth/virtual care

• Familiarity with or experience in Transitional Care Management (TCM) required

• Experience in primary care, geriatrics, post-acute care, long-term care, or complex care management preferred

• Proficiency with EMR systems and telehealth platforms

• Strong communication, clinical decision-making, and care coordination skills

• Experience managing medically complex adult or geriatric patients

• Experience working with interdisciplinary care teams

• Comfort discussing goals of care and advanced care planning

• Strong documentation and organizational skills

• Patient-centered and compassionate

• Confident making clinical decisions in a remote care environment

• Proactive, responsive, and detail-oriented

• Comfortable collaborating with both remote and on-site care teams

• Committed to improving outcomes and supporting care transitions

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