Description
The Integrated Care Physician/NP delivers comprehensive primary care and psychiatric services to individuals experiencing homelessness or formerly homeless individuals served by Janian Medical Care. Providers practice in a variety of community-based and non-traditional settings, including permanent supportive housing, transitional housing, safe havens, drop-in centers, mobile medical vans, clinics, and street-based outreach locations.
This integrated clinical role combines the functions of primary care and psychiatric treatment within a person-centered, community psychiatry model, allowing a single provider to address both physical and behavioral health needs. Providers deliver comprehensive medical care, psychiatric evaluation, medication management, brief psychotherapy, and care coordination while working collaboratively with interdisciplinary teams to address complex medical, behavioral health, substance use, and social needs.
Janian providers practice with a strong commitment to harm reduction, recovery-oriented care, trauma-informed care, and social justice. Providers are empowered to deliver flexible, creative, and patient-centered care that meets patients where they are and supports their individual goals.
The Integrated Care Physician/NP position is structured to include approximately 80-90% clinical time and 10-20% administrative and educational time, supporting documentation, care coordination, quality improvement participation, professional development activities, internal trainings, subcommittee work, supervision, and Grand Rounds participation.
Section 1. Essential Functions include, but are not limited to:
A. Clinical Responsibilities (Approximately 80-90%)
• Independently provide comprehensive primary care and psychiatric services to Janian clients across community-based, housing-based, mobile, and street-based settings.
• Engage patients in care wherever they are located, including medical offices within housing programs, onboard mobile medical vans, drop in centers, safe havens, soup kitchens and community outreach settings.
• Identify, engage, and retain individuals in medical and psychiatric treatment using person-centered and recovery-oriented approaches.
• Obtain comprehensive medical, psychiatric, substance use, and psychosocial histories through direct encounters, chart review, and collateral information from interdisciplinary staff, family members, and community partners.
• Conduct general, focused, and in-depth medical examinations and psychiatric evaluations in homes, shelters, clinics, supportive housing programs, and community-based settings.
• Diagnose and treat acute and chronic medical conditions, psychiatric disorders, and co-occurring substance use disorders within scope of licensure.
• Develop individualized, patient-centered treatment plans that integrate physical health, mental health, recovery goals, and social determinants of health.
• Prescribe and manage medical and psychiatric medications utilizing Janian practice standards and evidence-based clinical resources.
• Provide psychotherapy, supportive counseling, motivational interviewing, psychoeducation, and psychiatric interventions as clinically appropriate.
• Perform clinical procedures within scope of licensure, as applicable, including wound care, ECGs, phlebotomy, gynecologic and genitourinary exams, administer long acting injectable medications, incision and drainage, and suture or staple removal.
• Apply harm reduction principles and trauma-informed care practices in all clinical encounters.
• Utilize internal and external consultation resources such as RubiconMD, Epic Carelink, UCSF Warmline, psychiatric supervision, and Janian clinical guidance documents.
• Support patient recovery, self-determination, and wellness goals through collaborative treatment planning.
• Advocate for patients and address barriers related to housing, benefits, employment, healthcare access, and other social determinants of health.
• Implement population health initiatives targeting individuals with high medical, psychiatric, and social complexity.
• Serve as a consultative clinical resource to interdisciplinary teams, including social workers, psychiatrists, nurses, outreach staff, case managers, and housing providers.
• Participate in weekly interdisciplinary and clinical case conferences.
• Work independently at assigned sites while maintaining regular communication with colleagues and supervisors for consultation and care coordination.
• Maintain lower-volume schedules when appropriate to ensure high-quality care, adequate patient engagement, comprehensive documentation, and effective coordination for individuals with high-acuity needs.
• Complete timely and accurate clinical documentation in accordance with agency policy, billing standards, and regulatory requirements.
• Maintain active licensure, certification, and compliance with all Jania n and CUCS policies and procedures.
Administrative & Professional Development Responsibilities (Approximately 10-20%)
• Participate in administrative and educational time to support high-quality integrated clinical practice.
• Engage in continuing medical education (CME) and professional development activities to maintain licensure and clinical competency.
• Attend and participate in Janian Grand Rounds lectures, case conferences, trainings, and educational forums.
• Participate in regular supervision and consultation with Primary Care and Psychiatry leadership.
• Contribute to quality improvement (QI) initiatives, data review, population health projects, and program evaluation activities.
• Develop and deliver trainings for interdisciplinary staff, students, trainees, and community partners as appropriate.
• Participate in Primary Care, Psychiatry, and interdisciplinary subcommittees, workgroups, and meetings.
• Support care coordination activities, including communication with external providers, hospitals, specialists, behavioral health programs, and partner agencies.
• Collaborate with clinical leadership on workflow refinement, clinical protocols, practice improvement initiatives, and integrated care model development.
• Participate in opportunities for teaching, mentoring, and supervision of students and trainees when applicable.
Section 2. Expectations include, but are not limited to:
• Deliver high-quality, patient-centered, integrated medical and psychiatric care grounded in equity, dignity, and respect.
• Demonstrate flexibility, adaptability, and sound clinical judgment in non-traditional and community-based care environments.
• Maintain a recovery-oriented, strengths-based approach that supports patient autonomy and self-determination.
• Engage collaboratively with interdisciplinary teams and actively participate in supervision, consultation, and case review.
• Maintain accountability for documentation, patient follow-up, communication, and care coordination activities.
• Demonstrate commitment to harm reduction, trauma-informed care, diversity, inclusion, belonging, and social justice.
• Uphold Janian's mission, values, and commitment to addressing health disparities experienced by individuals impacted by homelessness.
• Represent Janian professionally and ethically in all internal and external interactions.
Section 2A. Integrated Care Appointment Structure
• The Integrated Care Physician/NP holds a joint clinical appointment across Janian Primary Care and Janian Psychiatry and is responsible for maintaining an active clinical practice within both service areas.
• Providers are required to maintain a minimum of seven (7) clinical hours per week within each department to remain in the dual-provider role.
• Clinical schedules, site assignments, and allocation of hours between departments are determined based on organizational and departmental needs.
• Compensation is commensurate with licensure, qualifications, and experience and is prorated according to hours worked in each department.
• The provider receives individual supervision from both the Primary Care supervisor and the Psychiatry supervisor.
• Educational activities, trainings, committee work, conferences, and departmental meeting attendance must be coordinated in advance, with both supervisors notified of planned participation.
• The provider will participate in quarterly joint supervision meetings with both supervisors to support professional development, performance review, workload alignment, and integration of services across departments.
Requirements
Education & Experience
For Physicians:
• Medical degree (MD or DO) from an accredited institution.
• Board certification or board eligibility in Psychiatry and Family Medicine, Internal Medicine, or another relevant specialty.
• Active license to practice medicine in New York State.
For Nurse Practitioners:
• Completion of an accredited Nurse Practitioner program.
• Active New York State Nurse Practitioner license and registration.
• Psychiatric Mental Health Nurse Practitioner (PMHNP) certification required or eligibility to obtain.
• Certification in Adult Medicine, Family Medicine, or other relevant specialty required.
• Additional certification or substantial experience in primary care preferred.
For All Candidates:
• Experience providing psychiatric care, primary care, or integrated behavioral health services.
• Experience working in community-based, safety-net, outreach, or underserved healthcare settings preferred.
• Experience working with individuals experiencing homelessness, serious mental illness, substance use disorders, or complex social and medical needs strongly preferred.
• Commitment to person-centered, recovery-oriented care and community psychiatry principles.
Certification / License
• Active New York State medical or nurse practitioner license.
• DEA registration required or eligibility to obtain.
• Board certification or board eligibility appropriate to discipline.
• PMHNP certification required for psychiatric nurse practitioners.
• Controlled substance prescribing authority as permitted by licensure.
Knowledge, Skills, and Abilities
• Strong clinical judgment and ability to manage complex medical, psychiatric, and social needs.
• Ability to provide integrated physical and behavioral healthcare in community settings.
• Commitment to harm reduction, trauma-informed, person-centered, and recovery-oriented care.
• Understanding of social determinants of health and their impact on clinical outcomes.
• Ability to work independently while collaborating closely with interdisciplinary teams.
• Proficiency with electronic medical records (eClinicalWorks preferred).
• Strong organizational, communication, and time-management skills.
• Ability to engage individuals who may be ambivalent about treatment or disconnected from traditional services.
• Demonstrated commitment to servant leadership principles, continuous learning, diversity, inclusion, and belonging.
Physical Demands
The physical demands described below are generally required to perform the essential functions of this role. Reasonable accommodations may be made.
1. Sit and stand for extended periods of time.
2. Walk, bend, reach, grasp, push, and pull.
3. Lift and carry supplies or equipment weighing up to 20 pounds.
4. Work in clinic-based, housing-based, mobile, and street-based environments.
5. View computer screens, read written materials, and enter data into electronic systems.
6. Travel between program and outreach locations as required.
? Community-based position ? Field-based work possible depending on assignment
