Geriatric Nurse Practitioner - (Bellevue, Renton, Kent)

"A New Approach to an Age-Old Need" - Pathway Geriatrics is a nurse practitioner-owned medical startup headquartered in Redmond, WA, currently serving the Greater Seattle area. We provide in-home primary care services for homebound older adults. Said differently, we bring our medical services to our clients, who often can't leave their homes to get the specialized care they need.

We have a uniquely deep background in technology (and tech startups), which heavily influences our workflows and culture. Our vision is to build a new type of medical practice that melds the latest technologies and best practices with the caring hearts of top-tier providers.

The Basics

We are looking for a certified Geriatric Nurse Practitioner to serve as a primary care provider in our Bellevue/ Renton/ Kent region. New graduates are welcome. Very few providers have experience with high-complexity home-based medical care, so everyone will receive training specific to their experience and skill sets. 

The position is fully field based, although we do have occasional team meetings at our Redmond office.

Typical business hours are 9:00 AM to 5:00 PM, Monday - Friday.

Compensation

Compensation typically ranges from $130,000 to $160,000, depending on experience and performance. High performers also have the potential to earn additional discretionary bonuses.

The Job Details

You will serve as the PCP for a panel of about 250 homebound older adults in your region. Most of our clients live in Adult Family Homes (AFH), with a portion residing in assisted living facilities. We often have several clients at each home. We aim to visit each facility every five to six weeks, and clients are seen based on medical necessity.

Our providers also facilitate each client's medication and chronic care management between in-person appointments.

We do our best to keep clients out of the emergency room. While we don't provide in-home urgent care (yet), we can often manage urgent situations remotely with help from our local network of in-home diagnostic services. These include mobile imaging, ultrasound, phlebotomy, and urinalysis/urine cultures.

Your Clients

The nature of our services means we often work with multiple parties when coordinating patient care. We typically have at least three clients per patient: the patient, their medical power of attorney, and their caregiver (typically an Adult Family Homeowner).

A typical client is 75+ years old and often in their final years. Most clients are homebound due to advanced dementia, but many also have other chronic diseases like osteoarthritis with contractures and pain, Parkinson's disease, heart failure, and diabetes. That said, we also work with younger adults who are homebound due to traumatic brain injuries, strokes, or mental health conditions.

Our clients' family members and powers of attorney have varying levels of engagement and knowledge. We are transparent and communicative with them and aim to serve as a resource for them and their loved ones.

The Office

The job is 100% "work from homes." :) On a given day, you will visit clients at between one to five different homes or facilities. Each Adult Family Home is someone's house in a regular neighborhood that the state has licensed to care for (around six) homebound adults. 

Be prepared to pull out your laptop and perform your visits on the family couch, at the dining room table, or perched on a client's bedside. Adult Family Homes are unique settings that genuinely feel like family for these older adults, where they live in a small and compassionate environment, and their caregivers know them well. Their intimate knowledge of each client's habits and expressions often helps us fill in the gaps when clients cannot speak for themselves. We develop a rapport and work together with the caregivers since they have the knowledge that allows us to target the root of a person's "agitation" and find the right fit for a client's treatment.   

Requirements

Our practice approaches issues from a palliative care perspective. Our primary goal is to improve client comfort and quality of life while reducing unnecessary medications. We monitor disease progression and consider when they should transition to hospice services. We usually continue as the client's attending provider while they are on hospice, managing their end-of-life care.

We see many routine problems day-to-day, but we are also frequently surprised by things we've never seen before.

• We often work with dementia-related behavioral concerns expressed through tearfulness, restlessness, physical aggression, combativeness, and sleep difficulty. 

• As our clients grow weaker, they will transition from walkers to wheelchairs to hospital beds and require our assessments and orders to coordinate that equipment.

• We partner with local home health care teams when our client needs skilled nursing, physical and occupational therapy, speech therapy, and psych nursing.

• Adult family homes also have special state regulations, so they need us to provide specific orders and permissions for their inspection requirements.

Typical Medications We Work With

Many dementia behaviors are managed with psychotropic medications. As such, we need you to be comfortable weighing the risks and benefits of applying antidepressants, antipsychotics, anticonvulsants, and others to help our clients with their quality of life.

We also strive to reduce or stop unnecessary medications. Standard "adult" guidelines often don't apply to a geriatric population. You will also need to be comfortable managing specialty medications, including those for cardiac issues and diabetes.

Other Tidbits

Personal Vehicle: You will need one.

On-call: We are available to our clients 24/7 for urgent needs, including holidays, weekends, and nights. We rotate being on-call evenly between our providers, answering urgent calls and messages. It won't require physically going to a facility after hours, just triaging over the phone. For your reference, most nights, we don't have any calls.

Giving Back: We try to give back to our community in many ways, and we ask all our employees to participate. Contribution examples might include writing an article for our (upcoming) blog, precepting a nursing student, or teaching a class at the local senior center.

Software Feedback: We're developing a proprietary healthcare tech platform designed explicitly for in-home patient care. Our engineers will work with you from time to time while designing and testing our software platform to streamline operations (i.e., make your life easier).

Benefits

Benefits

In addition to your compensation, we provide each provider with:

·      Malpractice insurance

·      PTO (vacation + sick leave)

·      Nine paid holidays (six are set, three you get to pick)

·      Top-notch low deductible Health Insurance (Medical, Dental, Vision) with an FSA

·      401K with company matching (up to 4%)

·      Life & Disability Insurance

·      Workers Comp