At firsthand, our Nurse Practitioners are referred to as Health Guides (HGs). Our HGs are dedicated and compassionate advocates leading the individuals we serve on a journey towards wellbeing and recovery.
HGs lead the medical aspects of team-based care for individuals with serious mental illness that firsthand serves. They are responsible for whole person assessment and management of our vulnerable population, collaborating closely with community primary care and behavioral health providers, as well as an internal team of firsthand Guides (Certified Peer Recovery Specialists) and Community Resources Guides (social services personnel).
As a HG, you will perform a whole-person clinical assessments, including:
- Assessing both behavioral and physical health conditions with a thorough history and physical examination
- Verifying previously diagnosed conditions and capturing conditions not yet diagnosed based on review of medical records, evidence-based practice, clinical judgment and diagnostic studies. ,
- Overseeing transitions of care by conducting post-hospital discharge visits to ensure a stabilizing plan is in place to avoid unnecessary rehospitalizations.
- Conducting visits in the in the office, virtually, in the field, or in an individual’s home when needed
- Ensuring continuity of care, referring to community primary and behavioral health providers and specialists based on assessed needs
- Supporting individuals in developing and exercising self management skills and person-centered care around their individual goals and preferences via motivational interviewing and holistic care planning
- Organizing clinical information in a manner that supports appropriate clinical documentation criteria for successful disability applications (if appropriate)
- Collaborating with a team of clinical documentation specialists, certified coders, and medical assistants
As a HG, you will lead the medical component of the team-based care provided by firsthand, including:
- Training and advising roles like Medical Assistants, and Peer Recovery Specialists on behavioral, clinical, and social health priorities
- Supporting care coordination
- Leading care and disease management and identifying actionable care gaps
- Communicating and coordinating with individuals’ care providers, primarily at CMHCs, FQHCs, and hospitals
- Providing direct patient care when unscheduled care needs cannot be met by existing community providers
As a HG, you will collaborate with other team members to provide integrated care:
- Assist firsthand Guides (peer specialists) with engagement and recovery support
- Work with the firsthand Care Team and the Community Resources Guide in supporting individuals’, SDOH needs and with medical eligibility assessments for disability applications.
You will be a good fit if you have:
- Excellent clinical acumen in outpatient chronic disease and behavioral health care
- 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 and typing proficiency - experience with Electronic Health Records, familiarity with Google Suite a plus
- Ability to operate a vehicle, including a driver’s license that is active and in good standing; must be eligible to drive under Company insurance policy
The experience you bring to the role includes:
- 5+ years clinical care as a Nurse Practitioner or Physician Assistant, ideally in a primary care setting
- Working with and managing a population 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 experience.
