Nurse Practitioner - Primary Care and Value Based Care

Overview
Our company is changing the way individuals living with Serious Mental Illness (SMI) get care. We are focusing on delivering real outcomes for a cohort that has historically been underserved, stigmatized, and deprioritized. By building a service focused on whole-person care, firsthand aims to find, establish a trusting relationship with, and support quality care for individuals living with complex experiences of SMI. Our company’s high-touch model will dramatically improve the health and outcomes of its engaged individuals, driving down the utilization of high-cost care while also helping individuals enroll in eligible federal, state, and municipal benefits. Most importantly, our goal is to be the trusted guide, partner, and first call for individuals we serve, guiding them to a life of stability and independence.

In doing so, we will not only improve lives, but also improve the economics for managed care plans and states responsible for providing care to this community. This enables us to build solutions that scale and, as a result, change the way our society supports those most impacted by serious mental illness.

We are building a team of deeply passionate problem-solvers who are courageous enough to take on one of the country’s most challenging healthcare problems. Those who are up for the task will be rewarded with deeply mission-oriented workdays, mentorship from a similarly motivated team, and a voice at the table in the earliest stages of business building.

The licensed Nurse Practitioner who leads the medical aspects of team-based care for individuals with serious mental illness that we serve. This position is responsible for documenting and supporting the medical needs of the individual, by performing a whole-person clinical assessment to identify and remediate care gaps. On an ongoing basis, this position will support care coordination among the individual’s medical and behavioral health providers, making referrals as appropriate, as well as provide clinical support to Guides (peers) and Community Resources Guides (social workers).

You will:
Perform a whole-person clinical assessment, including:
- Gathering information from outside sources (especially other care providers)
- Assessing both behavioral and physical health conditions through a thorough history and physical examination
- Capturing conditions not yet diagnosed, including by ordering additional studies as indicated
- Organizing the information in a manner that supports successful disability applications (if appropriate)
- Conducting visits in the field or in an individual’s home when needed
- Making individualized recommendations and/or referrals for programs/care provided by firsthand or outside providers, based on the assessed need

Lead the medical component of the team-based care provided, including:
- Training and advising firsthand Guides and Community Resources Guides on clinical issues and treatments
- Supporting Guide Team on care coordination
- Leading care management - identifying actionable care gaps
- Performing medication reconciliation post-discharge and as needed
- Communicating and coordinating with individuals’ care providers, primarily at CMHCs, FQHCs, and hospitals

You will be a good fit if you have:
- Empathy, compassion, and approachability
- Excellent listening, communication, and interpersonal skills
- Desire to help people in need and support their path to wellness
- Comfort working as part of a multidisciplinary team, and enjoy mixed roles and duties - this is a mix of direct service, teaching, and care management
- Cultural humility, knowledge of trauma informed care, and social determinants of health
- Desire to perform data driven care
- Familiarity with local providers
- Ability to maintain professional boundaries and engagement skills with a population with challenges and in non-traditional work conditions
- Intermediate computer skills, familiarity with Microsoft Office Suite
- Driver’s license, private auto insurance, and be insurable under firsthand coverage

The experience you bring to this role includes:
- 5+ years clinical care as a Nurse Practitioner, ideally in a primary care setting
- Working with and managing underserved populations with challenges such as behavioral health and/or SUD conditions
- Developing and delivering educational programs to nurses and affiliated medical staff
- Care management and coordination
firsthand Benefits

A range of healthcare benefits offerings for yourself and/or your family
401(k) with employer matching program
Competitive and flexible paid time off policies
Choice of Mac or PC for laptop or tablet as needed

We firmly believe that great candidates for this role may not meet 100% of the criteria listed in this posting. We encourage you to apply anyway - we look forward to begin getting to know you.