Transitions Of Care Advanced Practice Provider (Healthcare)

TL;DR

Transitions Of Care Advanced Practice Provider (Healthcare): Providing virtual post-discharge care to prevent hospital readmissions with an accent on acute clinical judgment and longitudinal chronic-care planning. Focus on comprehensive medication reconciliation, managing complex geriatric patients in real-time, and optimizing whole-person care plans.

Location: Remote (USA). Must be based in the USA and able to work consistently within CST, MST, or PST time zones.

Salary: $120,000–$150,000/year base plus performance bonuses ($10k–$20k), for a total compensation of $130,000–$170,000/year.

Company

An all-in-one healthcare company combining insurance, clinical care, and technology to improve the health and well-being of older Americans.

What you will do

• Conduct comprehensive initial post-discharge assessments and virtual urgent-care visits for medically complex patients.
• Perform detailed medication reconciliation to optimize guideline-directed medical therapy and prevent contraindications.
• Manage the clinical trajectory of patients over a 30-day window to reduce hospital readmission risks.
• Collaborate within an interdisciplinary team of nurse case managers, social workers, and physicians.
• Contribute to quality-improvement projects and provide feedback on the proprietary EHR system.

Requirements

• 5+ years of experience in direct patient care for geriatric populations with complex comorbidities.
• Active and in-good-standing RN/APRN or Physician Assistant license.
• Licensure in FL, TX, AZ, OH, and/or GA required to start; must be able to obtain other state licenses within 60-90 days.
• Ability to work full-time schedule (8:30 AM – 5:00 PM) within CST, MST, or PST hours.
• Proficiency in managing high-readmission conditions such as heart failure, COPD, diabetes, and hypertension.

Nice to have

• Experience in internal medicine, hospital medicine, urgent care, or emergency medicine.
• Previous experience performing visits over telehealth video platforms.
• Experience working with frail populations in the skilled nursing facility (SNF) setting.

Culture & Benefits

• Employer-sponsored health, dental, and vision insurance with low or no premiums.
• Generous paid time off and a comprehensive parental leave program.
• Stock options for all employees and a 401K program.
• $100 monthly mobile or internet stipend.
• Collaborative, interdisciplinary team environment focused on compassionate care.