Nurse Practitioner

Summary

Join Strive Health and become a Transitional Care Management Nurse Practitioner, guiding patients discharged from acute and post-acute facilities back to community-based care. You will act as a clinical anchor, advocate, and navigator, preventing complications and coordinating care. Collaborate with a multidisciplinary team to ensure seamless transitions and high-quality kidney care. Accountabilities include patient outcomes and KPIs, collaborating with external providers, and performing clinical assessments. You will deliver primary and urgent care visits in various settings, including patient homes and clinics. Maintain current board certification and adhere to Strive's documentation policy. Strive Health offers a hybrid-remote work model, comprehensive benefits, financial support, paid time off, and wellness programs.

Requirements

• Master’s degree in Nursing with Nurse Practitioner Licensure
• 2+ years' experience as a Family Nurse Practitioner, Primary Care Nurse Practitioner, or experience in Internal Medicine, Family Medicine, Emergency Medicine, Urgent Care, Cardiology, or Nephrology settings
• Current state licensure, national board certification, and DEA license (or eligibility within 90 days of hire)
• Current BLS and/or CPR Certification
• Valid driver’s license and reliable transportation with the ability to travel. Locations may include offices, clinics, and patient homes
• Willingness and ability to provide virtual and in-person patient care which may include standing, sitting, walking, pushing, pulling, and lifting
• Internet Connectivity - Min Speeds: 3.8Mbps/3.0Mbps (up/down): Latency <60 ms

Responsibilities

• Lead Post-Discharge Care : Deliver timely, high-quality in-person or virtual visits for CKD/ESKD patients transitioning from hospital to home (or SNF). Provide urgent and primary care aligned with their short- and long-term needs
• Drive Outcomes : Be accountable for clinical outcomes and performance metrics (e.g., readmission rates, timely follow-up) for your patients
• Collaborate & Coordinate : Partner with internal and external providers (PCPs, nephrologists, NPs, CMs, dialysis centers, and SNFs) to align goals, coordinate care plans, and optimize outcomes
• Facilitate TCM Rounds : Attend weekly interdisciplinary rounds to support high-risk patients and guide care management teams
• Perform Clinical Assessments : Complete comprehensive histories, physical exams, diagnostic evaluations, and tailored treatment plans
• Advance Kidney Health : Embed CKD/ESKD best practices across the continuum, including management of comorbidities, renal replacement options, and advance care planning
• Visit Flexibility : See patients in various settings — home, partner clinics, dialysis centers, or virtually, depending on patient need
• Champion Transitions : Serve as a liaison to ensure smooth communication and continuity across sites of care
• Stay Sharp: Maintain licensure, certifications, and CE requirements. Adhere to documentation, compliance, and care quality standards
• Accountable for patient outcomes and KPI’s for a panel of CKD and ESKD patients
• Collaborates with external providers to ensure goals, treatment, and care plan alignment
• Attends TCM rounds weekly to review patients at high risk for readmission to provide support and guidance to the care management team
• Chart reviews and audits to ensure patient care is being delivered in accordance with Evidence Based Care
• Obtains patient history, performs physical exam, orders and interprets diagnostic tests and formulates a plan for individual patient short-term and longitudinal needs
• Presents patient cases and provides clinical support for clinical rounds and interdisciplinary team meetings
• Ensures assessment and plan of care incorporate best practices for chronic kidney care including CKD clinical care (management of all stages of CKD, co-morbidities, ESKD and support of transitions to renal replacement therapy, transplant, or conservative care) as well as participation in shared decision-making and end-of-life/advanced care planning discussions
• Serves patients and performs patient visits in multiple care settings as defined by role, including patient home, clinics (where applicable), partner MD space (where applicable), and via telehealth/virtual visits
• Serves as a liaison with dialysis facilities, PCPs, and nephrologists, providing care plan updates to help streamline the transitions in care
• Responsible for maintaining current board certification and state-specific continuing education requirements
• Adheres to expectations outlined in Strive’s documentation policy
• Deliver primary and urgent care visits to adult and geriatric patients with history of chronic kidney disease recently discharged from an acute or post-acute facility

Preferred Qualifications

• 2+ years working in EHR platforms; Microsoft Office proficiency
• Previous TCM experience and/or Wound care certification is a plus
• Experience using audio-visual and virtual care technology
• Prior CKD/ESKD, TCM, or population health experience is strongly preferred

Benefits

• Hybrid-Remote Flexibility – Work from home while fulfilling in-person needs at the office, clinic, or patient home visits
• Comprehensive Benefits – Medical, dental, and vision insurance, employee assistance programs, employer-paid and voluntary life and disability insurance, plus health and flexible spending accounts
• Financial & Retirement Support – Competitive compensation with a performance-based discretionary bonus program, 401k with employer match, and financial wellness resources
• Time Off & Leave – Paid holidays, flexible vacation time, sick time , and paid bi rthgiving , bonding, sabbatical, and living donor leave s
• Wellness & Growth – Family forming s ervices through Maven Maternity at no cost and physical wellness perks , mental health support, and an annual professional development stipend