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Habitat Health

PACE-based elder care provider and insurer

Medical Director

Physicians & SurgeonsConfirmed live in the last 24 hours
Full-timeChicago, IL, USA

About the Job

Requirements

  • MD or DO with active, unrestricted state licensure, a Drug Enforcement Administration license, and current board certification in Internal Medicine, Family Medicine, Geriatrics, or a relevant specialty.
  • At least 3 years of clinical experience caring for older adults and/or medically complex populations in PACE, geriatrics, skilled nursing facilities, hospice, home-based care, managed care, or a comparable integrated care setting.
  • Demonstrated strength in direct clinical care for complex seniors.
  • Experience leading clinicians and interdisciplinary teams through coaching, mentorship, and case-based teaching, with examples of building capability across multiple disciplines.
  • Experience in value-based or capitated care models and comfort using clinical, utilization, and quality data to improve outcomes and reduce avoidable utilization.
  • Strong communication, collaboration, and change-management skills, with the ability to influence across disciplines and partner effectively with operational leaders in a dyad model.
  • Commitment to participant-centered care and the What Matters Most framework, comfort with palliative and end-of-life discussions, high professional integrity, and ability to foster psychologically safe, inclusive team cultures.
  • Some local and regional travel may be required.

Responsibilities

  • Provide evidence-based, person-centered direct clinical care as a primary care provider for approximately 50% clinical panel, subject to census and operational need, and as supervising physician; collaborate with the interdisciplinary team on person-centered care planning across medical, behavioral, and functional domains.
  • Apply strong clinical judgment in evaluation, diagnosis, and management; apply geriatric principles including preventive care and harm reduction; produce high-quality documentation supporting continuity, coding integrity, and coordination; and lead safe medication management, including deprescribing and polypharmacy reduction.
  • Oversee and monitor care across clinic, home, inpatient, and skilled nursing facility settings; recognize early functional and cognitive decline and evolving needs; lead goals-of-care conversations; and use complex cases as interdisciplinary team teaching opportunities.
  • Be accountable for clinical quality, safety, outcomes, and participant experience; chair the Quality Improvement Committee; and use utilization and safety data, including emergency department rate, hospitalizations, readmissions, satisfaction, and disenrollment, to drive measurable improvement.
  • Lead root cause analyses, implement corrective actions, maintain working knowledge of Centers for Medicare & Medicaid Services PACE regulations, and oversee grievances, appeals, Clinical Laboratory Improvement Amendments-waived onsite lab compliance, and pre-enrollment clinical evaluations.
  • Oversee chart audits for documentation and coding integrity, monitor contractor performance, and lead medication-related and other program-level process improvements.
  • Oversee all physicians and advanced practice providers within the PACE operation.
  • Serve as a clinical educator and subject matter expert for interdisciplinary team members on geriatrics, the PACE model, behavioral health, medication safety, and the What Matters Most framework; provide regular case-based teaching across settings.
  • Provide direct coaching, mentorship, and timely feedback to clinicians; set clear expectations for clinical quality, documentation, communication, and follow-through; and address gaps constructively.
  • Partner with the Executive Director to foster high staff engagement, an inclusive culture, shared accountability for team member development, and employee experience.
  • Serve as dyad partner to the Executive Director, jointly accountable for center performance across quality, operations, culture, and financial sustainability; apply a value-based care mindset and partner on annual panel growth planning.
  • Serve as the primary clinical liaison with hospitals, skilled nursing facilities, home health agencies, specialists, and community providers; represent the center on enterprise committees; and communicate performance trends and risks to senior leadership.
  • Provide input to operational leadership on improvement and refinement of the clinical service delivery model as determined by the Chief Medical Officer.

Desired Qualifications

  • Prior experience as a Medical Director, Associate Medical Director, or comparable physician leader in PACE, integrated senior care, or value-based care environments.
  • Experience with Hierarchical Condition Category coding, documentation improvement, chart review, and audit readiness; familiarity with how clinical documentation affects quality reporting and risk adjustment.
  • Experience chairing or leading quality assurance and performance improvement, quality, utilization, or safety work, including root cause analysis and corrective action implementation.
  • Experience as a physician liaison with health system partners or referral networks; familiarity with Centers for Medicare & Medicaid Services PACE regulations and the 11-discipline interdisciplinary team model.

About the Company

Habitat Health

PACE-based elder care provider and insurer

Habitat Health coordinates medical care, social services, and daily living support for older adults to help them stay in their homes and communities. It operates under the Program of All-Inclusive Care for the Elderly (PACE), which lets it act as both a healthcare provider and an insurer, delivering a bundled set of services including primary and specialty care, mental health, prescription management, rehabilitation, transportation, nutrition support, adult day activities, and home visits within a single framework. The organization differentiates itself through its dual provider/insurer model and its home- and community-focused, holistic approach, starting with a Sacramento pilot in partnership with Kaiser Permanente and backed by major venture investors. Its goal is to expand access to integrated, coordinated care for seniors, helping them maintain independence and avoid long-term institutional care.

Company size
51-200
Company stage
Early VC
Total funding
$50M
Headquarters
San Francisco, CA
Founded
2023

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