Nurse Practitioner (Remote from MI, OH, IL or IN)

What We Strive For 

At Strive Health, we’re driven by a purpose: transforming the broken kidney care system. Through early identification, engagement, and comprehensive coordinated care, we significantly improve outcomes for people with kidney disease, reducing emergency dialysis and inpatient utilization. Our high-touch care model integrates with local providers and uses predictive data to identify and support at-risk patients along their entire care journey. We embrace diversity, celebrate successes, and support each other, making Strive the destination for top talent in healthcare. Join us in making a real difference. 

Benefits & Perks 

• 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 birthgiving, bonding, sabbatical, and living donor leaves.
• Wellness & Growth – Family forming services through Maven Maternity at no cost and physical wellness perks, mental health support, and an annual professional development stipend. 
  

Who You Are 

You’re a purpose-driven provider with a passion for delivering high-quality care, particularly in the critical transition from hospital to home. You understand that moments of vulnerability are also moments of opportunity — and you're eager to use your clinical skill, empathy, and leadership to reduce readmissions, build trust, and improve outcomes for people living with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). 

What You’ll Do 

As a key member of Strive Health’s interdisciplinary care team, the Transitional Care Management Nurse Practitioner will guide patients recently discharged from acute and post-acute facilities through a safe, supportive return to community-based care. You’ll act as a clinical anchor, advocate, and navigator — preventing complications, coordinating next steps, and delivering hands-on primary and urgent care. 

You’ll collaborate with Strive’s full-spectrum clinical team, including physicians, pharmacists, social workers, dietitians, case managers, and care coordinators, to ensure high-quality, seamless transitions that reflect the best in evidence-based kidney care. This role will work in close partnership with and under the guidance of the TCM Regional Medical Director.  

The Day-to-Day  

• 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 

Key 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. 

Minimum Qualifications 

• 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. 

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. 

About You 

• Demonstrated proficiency in clinical assessment, diagnosis, planning, implementation, documentation, and evaluation of complex chronic patients.  
• Excellent communicator, team builder, and evidence of results. 
• Demonstrated knowledge and understanding of data and managing clinical, financial, and patient satisfaction outcomes.  
• Excels at developing and fostering strong patient and family relationships that center on engagement, trust, honesty, empathy, follow-through and doing what’s best for the patient.   

Who Thrives Here

• Professionals who are patient-centric, data-informed, and outcomes-driven. 
• Providers who value relationships over transactions and quality over volume. 
• Demonstrates expertise in chronic disease management and evidence-based practices to optimize outcomes and reduce acute care utilization.  
• Effective communicator and collaborative leader with a focus on building high-performing teams and delivering high-impact results.  

Why Strive 

Strive Health is transforming care by putting patients at the center — prioritizing prevention, optimizing outcomes, reducing readmissions, and helping people live longer, healthier lives. 

This is where purpose meets post-acute care, where mission meets medicine, and where transitional care becomes transformational care! Join us and be part of the care revolution — transforming transitions, improving lives, and building the future of care delivery!  

Annual Salary Range: $109,000.00-$150,000.00

Strive Health is an equal opportunity employer and drug free workplace. At this time Strive Health is unable to provide work visa sponsorship. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law. Please apply even if you feel you do not meet all the qualifications. If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talentacquisition@strivehealth.com.

We do not accept unsolicited resumes from outside recruiters/placement agencies. Strive Health will not pay fees associated with resumes presented through unsolicited means.

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