Position Description:Circadia Health is launching a new proactive model of care aimed at improving outcomes through early intervention and consistent monitoring in skilled nursing facilities (SNFs). As part of this Proactive Care Program we are seeking a dedicated Nurse Practitioner (NP) to lead on-the-ground efforts across two partner SNFs in New Jersey located 13 miles apart.
The NP will play a critical role working with the entire facilitys patient population (short and long term). This includes identifying and managing patients at risk including new admissions patients with out-of-range vitals (e.g. blood pressure blood sugar weight) those flagged by facility staff Circadias AI Predictive Model and/or patients with behavioral health needs.
You will play a crucial role in our mission to enhance patient care through innovative solutions. You will be responsible for performing in-person patient assessments prescribing necessary medication and treatments developing individualized care plans and collaborating with the interdisciplinary team to ensure the highest standards of care.
Key Responsibilities
Proactive In-Facility Rounding: Conduct initial and routine assessments on patients prioritizing those flagged by Circadias AI powered monitoring system or facility staff. Prescribe all necessary medications and treatments under the covering physician agreement.
Data - Driven Patient Identification: Review alerts and trend analyses generated by Circadias platform to identify early signs of clinical deterioration. Verify and act on facility-initiated notifications within agreed response times.
Personalized Care Planning: Develop and update patient-specific care plans that integrate AI insights evidence-based guidelines and resident and monitor threshold-based interventions (e.g. BP glucose weight parameters).
Interdisciplinary Collaboration & Education: Coordinate with facility clinical teams to ensure seamless hand-offs and follow-through on escalations and interventions. Communicate with physicians and/or specialists regarding patient care. Provide education to facility staff on Circadias platform and AI insights.
Continuous Quality Improvement: Track key performance indicators (e.g. hospital transfers response times guideline adherence) and participate in regular QAPI meetings to drive outcome improvement.
KPIs
Minimum 20 patient visits per facility per day
Documentation completed within 24 hours for all patient assessments follow ups and any communications
Review all Circadia flags and reports the same day while rounding in facilities
Ensure individual care plans are up to date for any changes in condition new risk or goals
Partner with floor staff and nurses to ensure clinical follow-through on any interventions
Attend and participate at the facilities QAPI meetings
Provide brief in-services or huddles as needed
Track and review patient outcomes
Comfortable navigating Circadia alerts EMR and documentation tools
Qualifications
Certified and licensed as a Nurse Practitioner in NJ
Must have an active license and DEA #Medicare participation and ability to have company bill for services on your behalf
Certification from ANCC (or equivalent) as an Adult Family Geriatric and/or Acute Nurse Practitioner
2 years of Nurse Practitioner Experience working with complex adult populations
Current NJ Drivers License
Comfort using technology such as Google Suite multiple EMRs Slack AI transcription tools
Ability to thrive in a fast-paced environment
Comfortable in an adaptive and evolving environment
English required Spanish preferred
Benefits
Medical dental and vision coverage through AnthemBCBS (or equivalent)
401(k) with employee contribution option
Flexible PTO in accordance with company policy
Continuingeducation budget mentorship programs and regular training on emerging healthcare technologies
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