Geriatrician

Job Description The Geriatrician is responsible for delivering thorough, patient-focused medical services to elderly individuals in two main environments: (1) outpatient clinics and (2) community settings. This position is designed to allocate 50% of the time to in-clinic activities (evaluations, ongoing management, consultations) and 50% to community engagements (home-based primary care, visits to assisted living facilities and skilled nursing facilities, transitional care, and outreach efforts). The clinician will prioritize functionality, quality of life, medication safety, alignment of care goals, and seamless coordination throughout the healthcare continuum.Work Schedule & LocationSchedule: Full-time, with a 50% clinic / 50% community split.Clinic Location(s): Attleboro, MACommunity Coverage Area: Bristol & Norfolk CountiesTravel: Required for community visits; a valid driver's license and reliable transportation are necessary.On-call: None / Shared rotation / After-hours phone triageKey ResponsibilitiesA. Outpatient Clinic (50%)Comprehensive Geriatric AssessmentConduct thorough evaluations that encompass medical complexity, functional abilities, cognitive health, mood, fall risk, nutritional status, sensory impairments, caregiver support, and social determinants of health.Chronic Disease ManagementImplement evidence-based management strategies for prevalent geriatric conditions such as frailty, dementia, delirium risk, polypharmacy, osteoporosis, urinary incontinence, heart failure, COPD, and diabetes in older adults.Medication OptimizationConduct structured medication reviews, deprescribing when necessary, and ensure reconciliation following transitions of care.Cognitive and Behavioral Health CareDiagnose and manage conditions such as dementia, mild cognitive impairment, delirium risk, depression, anxiety, and behavioral symptoms in collaboration with caregivers and community resources.Preventive Care & Risk ReductionCustomize screening and preventive measures based on life expectancy, functional status, patient values, and clinical context; focus on fall prevention and mobility maintenance.Care Planning & Advance Care PlanningFacilitate discussions regarding care goals; document advanced directives/POLST/MOLST as appropriate; ensure treatment plans align with patient preferences.Consultation & Co-ManagementProvide geriatric consultations for complex cases and collaborate with primary care providers and specialists.B. Community-Based Care (50%)Home-Based and Community GeriatricsDeliver medical services in patients' homes and community locations (e.g., assisted living, adult day programs, supportive housing) for those facing mobility, cognitive, or access challenges.Post-Acute & Facility-Based Rounding (as applicable)Conduct continuity visits in skilled nursing facilities (SNFs) or other residential settings, coordinating with facility staff on care plans and safety measures.Transitional Care ManagementAssist with transitions from hospital to home (or SNF to home), ensuring timely follow-up, medication reconciliation, symptom monitoring, and coordination with home health services and caregivers.Urgent Access & Acute Issue Management (in scope)Assess and manage subacute changes (e.g., triggers for delirium, falls, dehydration, infection risk) while minimizing unnecessary emergency department visits and hospitalizations when clinically appropriate.Interdisciplinary Team CollaborationWork alongside nursing, social work, care management, pharmacy, physical/occupational therapy, behavioral health, and community organizations to address both medical and social needs.Caregiver Support & EducationOffer coaching for caregivers, anticipatory guidance, and connections to community resources.Safety & Environmental AssessmentIdentify potential home safety risks (e.g., fall hazards, medication storage issues, nutrition access, caregiver strain) and implement strategies to mitigate these risks.Cross-Cutting Responsibilities (Both Settings)Documentation & CodingEnsure timely and accurate documentation in the electronic health record (EHR); verify appropriate billing and coding for both clinic and community services.Quality & Population HealthEngage in quality improvement initiatives (e.g., falls prevention, polypharmacy management, reducing avoidable utilization, readmissions, dementia care metrics).CommunicationMaintain clear communication with patients, families, caregivers, and referring clinicians; provide concise care summaries and follow-up plans.Compliance & SafetyFollow organizational policies, privacy regulations, infection control standards, and safety protocols for community visits.Teaching/Leadership (optional)Mentor learners (residents, fellows, students) and contribute to the development of geriatrics and community care programs.Required QualificationsMD or DO from an accredited institution.Board Certified/Board Eligible in Geriatric Medicine (or Internal Medicine/Family Medicine with geriatrics expertise), as per organizational standards.Unrestricted medical license (or eligibility) in MA.DEA registration (or eligibility).Proven experience with complex older adults, chronic disease management, and interdisciplinary care.Willingness to travel for community visits; valid driver's license required.Preferred QualificationsExperience in home-based primary care, PACE, SNF/ALF rounding, or complex care management programs.Training or experience in palliative care, dementia care, or transitional care.Familiarity with telehealth and remote monitoring technologies.Previous involvement in quality improvement or program development.Core CompetenciesExpertise in geriatrics: frailty, multimorbidity, functional decline, cognitive disorders, polypharmacy, falls.Strong clinical judgment in making risk/benefit decisions for older adults.Patient- and family-centered communication; emphasis on shared decision-making.Team-based care, care coordination, and systems thinking.Cultural humility and a commitment to health equity.Organizational skills suited for mobile/community practice (time management, routing, documentation).Physical & Environmental DemandsAbility to work in outpatient clinical environments and community settings (homes/facilities).May require standing or walking, transporting medical equipment, and navigating various home environments (stairs, pets, limited space).Salary Range: $196,992.72 - $313,150.49Our organization is an equal opportunity employer. We do not discriminate based on race, color, creed, age, gender, sexual orientation, national origin, veteran status, or disability.