Job Description

UCSF physician assistants (PAs) are advanced practice providers (APPs) who possess the education, national board certification, California licensure, knowledge, clinical skills, and experience necessary to provide evidence-based patient care in their area of clinical practice. They provide routine, acute, critical, and specialty care as defined by their granted privileges/standardized procedures. These may include performing non-invasive or invasive procedures and operative first assist.

UCSF PAs are guided by and follow California regulations and the UCSF Medical Staff Bylaws, Rules and Regulations, and Policies*. They are authorized to exercise those privileges specifically granted to them by the Committee on Interdisciplinary Practice (CIDP), Executive Medical Board (EMB), and Governance Advisory Council (GAC),* and are expected to provide clinically indicated care that meets the applicable standard of care.

*UCSF-hired APPs whose UCSF clinical responsibilities require patient care at facilities/locations outside of UCSF Medical Center and Clinics must abide by California regulations and are expected to provide clinically indicated care that meets the applicable standards of care. Additionally, they must be credentialed and privileged and follow the Bylaws, Rules and Regulations, and Policies of those facilities/locations. Examples include but are not limited to Langley Porter Psychiatric Hospital (LPPH), Marin Health, UCSF Benioff Children's Hospital Oakland, UCSF Health Saint Francis & St. Mary's Hospitals and Clinics, Washington Hospital, and Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG).

Credentialing, privileging, and applying for health plan enrollment must be completed prior to the first working day.

UCSF Health requires all APPs working at UCSF Medical Center and Clinics** to be credentialed through the Office of Medical Affairs and Governance (OMAG) and privileged through CIDP, EMB, and GAC. This applies to APPs in inpatient and outpatient clinical settings at all UCSF Health facilities/locations. Procedure privileges are granted after the APP has demonstrated competency through the focused professional practice evaluation (FPPE) process and submitted activity logs via the UC Me e-Log.

Inability to comply with the requirements of OMAG/CIDP at all times will result in a leave of absence or suspension of privileges.

**UCSF-hired APPs whose UCSF clinical responsibilities require patient care at facilities/locations outside of UCSF Medical Center and Clinics must complete and maintain the credentialing and privileging requirements of those facilities/locations or will be placed on a leave of absence or have privileges suspended.

APPs are expected to be familiar with the productivity metrics in their clinical practice based on the essential responsibilities (phenotypes) below.

UCSF APPs are expected to demonstrate accountability for their own clinical practice, participate in patient and staff education, serve as resources for APPs, APP students/fellows, physician residents/fellows, nurses and other staff, exhibit leadership skills, and engage in the mentoring of newly hired APPs.
• Work with the physicians/surgeons/APP colleagues and other clinical and administrative staff to ensure efficient patient management based on accepted practice, including but not limited to, performing histories and physicals, pre-operative planning/coordinating with anesthesia/outside providers and PCPs as applicable, responding to change in patient status, providing needed prescriptions/evaluations/referral/treatments as permitted under their delegation of services agreement. Provide home health services and DME, DMV evaluations, referrals, consultations, PT, and order radiographic or diagnostic requests, specialized treatment privileges (e.g. chemotherapy with privilege certification). May also provide patient education, arrange follow-up appointments, and engage in any approved privileges the APP has completed the necessary proctoring or FPPE through OMAG prior to competency for independent practice and procedural activity.
• To evaluate, assess and create a documented plan of treatment per patient's presenting HPI or established plan of care under the collaboration/supervision of an attending physician in the EHR.
• To answer clinically relevant patient medical advice calls or during bedside communications or coordination with health care professionals, patients and their families as necessary.
• To independently or in a shared visit model, evaluate routine, acute, critical, new patients, or specialty consultations when needed or required and discuss with attending and staff as appropriate.
• Be able to interpret and act upon ordered tests, procedures, and radiographic studies.
• To assist in formulating and implementing protocols to improve efficiency in the clinical specialty.
• Effectively communicate with family or patients in person, telephone and/or other electronic modalities in a timely manner. Ensure in their absence, appropriate clinical coverage has been arranged for patient management and communication as appropriate.
• At all times adhere to all policies and procedures of UCSF Health in terms of HIPPA/Communication/Privacy/Code of Conduct, and any other UCSF or Med Center Policies, which includes meeting the encounter closure requirements of the Med Staff Bylaws.
• Mandatory attendance at APP UCSF Onboarding Sessions (5 X 2 hours over 12 months) for all new APP employees whether experienced or new to APP practice. Adhere to all scheduling and communication policies whether specific or as outlined in the collective bargaining agreement.
• The PA will be responsible to ensure they have met the chart review requirements of California SB337 as made available through the EHR (APEX).
• Some duties, essential or intrinsic to the job, but are performed routinely or periodically may be unique to the specific clinical services
• Will maintain and be able to provide, upon request, an up to date Delegation Services Agreement as required by CA State law.

IF INPATIENT:
• To assist in formulating and implementing protocols to improve efficiency in the clinical specialty/service/pathways.
• Engage in a timely and efficient discharge of patients on the inpatient service for which you are responsible.
• Assist in coordinating patient transfers within and outside UCSF Health according to policy.
• Be familiar with outcome metrics, guidelines, and expectations for providers in clinical specialty.
• May be act as first assist in the OR.

Outpatient

Adults (includes adolescent and geriatric patients)

Responsibilities

Use this space for job functions and duties, separated by % of time for each function, totaling 100%

Function

% of time

Duties

Inpatient - Direct Patient Care (may include some or all of the responsibilities listed)

0

1. Independently (independent APP encounter) or collaboratively (shared physician and APP encounter) evaluates and manages patients.
2. Includes taking histories, performing physical examinations, responding to changes in patient status, performing consults, ordering or furnishing medications/diagnostic tests/treatments/therapies/consultations/referrals/durable medical equipment (DME)/home health services.
3. Care provided must be documented in the electronic medical record in accordance with the UCSF Rules and Regulations.
4. Provider services must be billed to reflect the performing provider and comply with the APP Billing Policy 3.08.01.
5. APPs must respond to clinical documentation integrity inquiries from the Department of Quality and Patient Safety within 3 days.

1.2. Performs procedures granted to them via privileges/standardized procedures.

1.3. Identifies patients with acute decompensation or failure and responds to the hospital plan of care and reviews with physician.

1.4. Initiates consultations as indicated.

1.5. Documents independent assessment findings and recommends appropriate treatments.

1.6. Participates in service rounds and patient evaluation and treatment planning.

1.7. Reviews lab tests, x-rays, and other diagnostic tests, and initiates appropriate team plans.

1.8. Evaluates complex cases, establishes individualized plans of care for disposition to a lower level of care.

1.9. Interprets and acts upon completed tests, procedures, and radiographic studies.

1.10. Completes clinically relevant paperwork/electronic health record (EHR) documentation, including but not limited to ordering medications, completing episodic care notes and discharge summaries in accordance with the UCSF Rules and Regulations.

1.11. Effectively communicates findings, treatment options, and care plans with patients and their families

1.12. May first assist in the operating room if privileged to do so through OMAG after completing the required certification and proctoring.

1.13. Monitors and evaluates patients for discharge. Sets parameters and guidelines for continuum of care with multi-disciplinary team. This includes evaluating and defining discharge regimen.

1.14. Discharges patients including prescribing/furnishing medications, ordering DME, and recommending or referring for ongoing follow up care, providing discharge teaching, and completing discharge summaries.

Inpatient - Care Coordination (may include some or all of the responsibilities listed)

0

1.1. Coordinates care throughout the continuum including hospital admission, care coordination with staff and consulting services, and hospital discharge planning.
1.2. Coordinates episodic care and determines timing of routine clinic follow up.
1.3. Participates in huddles with clinic/hospital staff and anticipates patients who require close management or intervention.
1.4. Consults with nursing staff on plan and implementation of individualized nursing care plans.

1.5. Independently provides case summaries for disability, insurance agencies, workers compensation, work releases, and medical supply agencies.
1.6. Formulates and implements protocols to improve quality and efficiency and control waste in the clinical specialty.

Outpatient - Independent Encounters (may include some or all of the responsibilities listed)

85

1. Evaluates and manages patients in independent APP encounters, including telehealth.
2. Includes providing care to new, follow-up, acute, routine, and specialty patients.
3. Includes taking histories, performing physical examinations, interpreting diagnostic tests, formulating evidence-based assessments and plans, responding to changes in patient status, and ordering medications/diagnostic tests/treatments/therapies/consultations/referrals/durable medical equipment (DME)/home health services.
4. Reviews or collaborates with attending physician as needed.
5. Care provided must be documented in the electronic medical record in accordance with the UCSF Rules and Regulations.
6. Provider services must be billed to reflect the performing provider and comply with the APP Billing Policy 3.08.01.

1.2. Performs procedures individually granted to them via standardized procedures/privileges.
1.3. Identifies high-risk groups and complex cases for review with attending physician. Initiates consultations as appropriate.

1.4. Evaluates complex cases, establishes individualized plans of care for rehabilitation, and facilitates occupational and physical therapy and physical medicine and rehabilitation consultations.
1.5. Interprets and acts upon the ordered tests, procedures, and radiographic studies in a timely fashion.

1.6. Completes clinically relevant paperwork/EHR, including but not limited to ordering medications, completing episodic care notes and telephone encounters.

Outpatient - Shared Encounters with Physician(s) (may include some or all of the responsibilities listed)

10

1. Evaluates and manages patients in shared encounters with attending physician, including telehealth.
2. This should increase clinic access with a goal of doubling clinic volume since two providers will be sharing the clinic responsibilities.
3. Includes providing care to new, follow-up, acute, routine, and specialty patients.
4. Includes taking histories, performing physical examinations, interpreting diagnostic tests, collaborating on evidence-based assessments and plans, responding to changes in patient status, and ordering medications/diagnostic tests/treatments/therapies/consultations/referrals/durable medical equipment (DME)/home health services.
5. Care provided must be documented in the electronic medical record in accordance with the UCSF Rules and Regulations
6. Provider services must be billed to reflect the performing provider and comply with the APP Billing Policy 3.08.01.
   
   1. May first-assist in the operating room if privileged to do so through OMAG after completing the required certification and proctoring.

1.3. Identifies high-risk groups and complex cases for review with attending physician. Initiates consultations as appropriate.

1.4. Evaluates complex cases, establishes individualized plans of care for rehabilitation, and facilitates occupational and physical therapy and physical medicine and rehabilitation consultations.
1.5. Interprets and acts upon the ordered tests, procedures, and radiographic studies in a timely fashion.

1.6. Completes clinically relevant paperwork/EHR, including but not limited to ordering medications, completing episodic care notes and telephone encounters.

Outpatient - Care Coordination (may include some or all of the responsibilities listed)

5

1.1.Coordinates care throughout the continuum including hospital admission, care coordination with staff and consulting services, and hospital discharge planning. DOES not include management of inpatients.
1.2. Management of the EHR, including patient and staff messages and other inbasket tasks.

1.3. Coordinates episodic care and determines timing of routine clinic follow up.
1.4. Participates in huddles with clinic/hospital staff and anticipates patients who require close management or intervention.
1.5. Attends department quality improvement meetings a