Nurse Practitioner: Transitional Care

About Cardea Health:  

Cardea Health is a non-profit organization dedicated to providing compassionate health care to marginalized populations. Our mission is to create and support programs that protect the health and autonomy of vulnerable individuals and promote equity and social justice to improve the well-being of our entire community. We provide medical support to populations that experience homelessness.  

At Cardea, we are dedicated to creating a workplace that celebrates diversity and actively seeks to include underrepresented communities. We believe that diversity drives innovation and fosters a more dynamic, inclusive, and productive work environment. We actively encourage individuals from underrepresented backgrounds to apply for our open positions. We value your unique perspectives, experiences, and talents, and we are committed to providing equitable opportunities for growth and advancement. Join us in building a team that reflects the rich diversity of our society and let's make a positive impact together. 

Primary Work Location:  

MULTISITE:  Multisite staff work across several program locations throughout Alameda County, providing care and support wherever it is most needed. These sites offer a range of services, including post-hospitalization medically supported shelter, medical respite care, skilled nursing, and caregiving support.

Job Summary:  

Cardea Health is seeking an experienced Nurse Practitioner to provide transitional medical and behavioral health care for individuals residing in interim and permanent housing sites throughout Alameda County. This role supports medically and socially vulnerable populations, including individuals experiencing homelessness who are disconnected from benefits, primary care, and specialty services. 

The Nurse Practitioner will evaluate new admissions, identify critical gaps in care, and provide short-term clinical coverage while clients await connection to ongoing primary or specialty providers. Responsibilities include prescribing medications, managing acute and chronic conditions, overseeing wound care, providing medication-assisted treatment for substance use disorders, and collaborating closely with nursing, behavioral health, and substance use navigation teams. 

Responsibilities:  

• Evaluate New Admissions: Assess new admissions to medically supported interim housing programs, identifying critical gaps in both medical and behavioral health care needs 

• Prescribe Gap Coverage: Prescribe medications and treatments for individuals lacking access to essential care while they await connection to primary or specialty providers 

• Wound Care Management: Evaluate individuals with chronic or acute wounds lacking specialized care; order and monitor wound care, tracking healing progress and identifying signs of infection 

• Maintain Critical Care Panel: Oversee a panel of critically ill patients across various sites. Collaborate with the nursing team to ensure effective clinical monitoring, treatment delivery, and progress assessment 

• Substance Use Disorder (SUD) Support: Work closely with the substance use navigation team to identify individuals with substance use disorders. Provide medication-assisted treatment (MAT) as needed 

• Warm Handoffs to External Providers: Facilitate smooth transitions for clients by ensuring proper handoff to external primary care providers upon connection 

• Policy & Procedure Development: Actively participate in the development and feedback of practice policies and procedures to improve clinical practices 

• Referral Resource Utilization: Develop an in-depth knowledge of local and regional referral resources and actively incorporate them into patient care 

• Data Collection & Research: Collect and import data for research, quality assurance, and quality improvement initiatives 

• Adherence to Protocols: Follow Standard Operating Procedures (SOPs) for clinical practices as a nurse practitioner, adhering to relevant state, county, and healthcare regulations 

• Harm Reduction & Client Autonomy: Provide care that respects client autonomy and incorporates harm reduction principles in all clinical interactions 

Minimum Required Skills & Qualifications:  

• Active Nurse Practitioner license issued by the State of California Board of Registered Nursing 

• Graduation from a Nurse Practitioner program accredited by the State of California Board of Registered Nursing, with a Master of Science in Nursing degree 

• Prior possession of a DATA 2000 waiver for the prescribing of buprenorphine for opioid use disorder (OUD) 

• Current Drug Enforcement Administration (DEA) certificate and furnishing number 

• Furnishing number issued by the State of California Board of Registered Nursing 

• Minimum of 2 years’ experience providing medication-assisted treatment (MAT) in a family medicine, internal medicine, addiction medicine, or psychiatric practice setting 

• At least 2 years’ experience treating patients with serious mental illness, substance use disorders, and co-occurring conditions (dual diagnosis) 

• Minimum of 3 years of clinical nursing experience 

• Current Basic Life Support (BLS) certification 

• Strong communication skills with the ability to establish effective provider-patient relationships that promote engagement and adherence to collaboratively developed care plans 

• Ability to balance risk and benefit, coupled with a strong aptitude for problem-solving 

• Experience working with homeless or incarcerated populations is highly desirable

Physical Requirements:  

• Occasional sitting or stationary work 

• Frequent standing, walking, kneeling, stooping, and ascending stairs 

• Occasional lifting and carrying up to 20 lbs 

• Frequent pushing and pulling 

• Frequent reaching high, low, and level 

Work Environment:  

• In-person onsite at a supportive housing facility. Constant work around and/or with people OR Interaction with patients, clients, and external customers

Benefits: 

Employees in this role may be eligible for a range of benefits, including  

• Employer-supported medical,  

• Access to dental and vision insurance,  

• Paid vacation and sick time,  

• Retirement plan (401k) participation with a company match,  

• Commuter benefits,  

• Long Term Disability,  

• Life Insurance 

• Eligibility for certain benefits may vary based on hours worked per week and length of employment.  

• Specific details are provided in the benefits guide and are subject to change 

Cardea Health is an Equal Opportunity Employer 

Cardea Health is committed to diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, age, gender identity or gender expression, genetic information, marital status, national origin, disability, citizenship or veteran status. We will consider qualified candidates with criminal histories in a manner consistent with the requirements of the state of California and San Francisco Fair Chance Ordinance. 

This job description is not designed to contain a comprehensive list of activities, duties, or responsibilities for this role. Activities, duties, or responsibilities may change, or a new job description may be assigned at any time with or without notice.