Virtual Transitions of Care AP - Post-Discharge Leader

Devoted; Northern (KY); On-site; USD 120,000 - 150,000; Full time

Benefits offered by this job

Employer-sponsored health insurance

Dental plan

Vision plan

Generous paid time off

$100 monthly mobile/internet stipend

Stock options for all employees

Bonus eligibility for all roles

Parental leave

401K program

Job summary

Devoted Health is seeking an experienced Advanced Practice Provider (NP/PA) to lead Transitions of Care for high-risk, elderly patients. The role blends initial post-discharge evaluation with ongoing chronic-disease management in a fast-paced, interdisciplinary team.

You will perform comprehensive TOC visits, optimize medications, and coordinate with RNs, social workers, and PCPs. A strong interest in building a robust TOC program and improving the EHR is essential.

Qualifications

• 5+ years of direct patient care managing geriatric populations with multiple chronic, complex conditions.
• Experience across acute and chronic presentations.
• Telehealth visit experience is a plus.
• Post-acute medicine or geriatrics experience preferred.

Responsibilities

• Perform comprehensive initial TOC visits and post-discharge assessments.
• Complete post-discharge medication reconciliation and optimize medical therapy.
• Place orders, provide education, and communicate contingency plans.
• Conduct acute/virtual urgent-care TOC visits and manage symptoms.
• Manage clinical trajectory within the 30-day window and adjust plans.
• Participate in interdisciplinary TOC rounds and collaborate with care teams.
• Support EHR improvements and clinical education initiatives.
• Contribute to quality-improvement projects and pilots.

Skills

Geriatrics

Telehealth

Acute care

Chronic disease management

Team collaboration

Education

Nurse Practitioner license

Physician Assistant license

Job description

Devoted Health is seeking an experienced Advanced Practice Provider (NP/PA) to lead Transitions of Care for high-risk, elderly patients. The role blends initial post-discharge evaluation with ongoing chronic-disease management in a fast-paced, interdisciplinary team.

You will perform comprehensive TOC visits, optimize medications, and coordinate with RNs, social workers, and PCPs. A strong interest in building a robust TOC program and improving the EHR is essential.