About Us:

Cityblock Health is the first tech-driven provider for communities with complex needs—bringing better care to where it’s needed most, block by block. Founded in 2017 on the premise that “health is local” and based in Brooklyn, we are backed by Alphabet’s Sidewalk Labs along with some of the top healthcare investors in the country.

Our mission is to improve the health of underserved communities. Importantly, our solutions are designed specifically for Medicaid and lower-income Medicare beneficiaries, and we meet our members where they are, bringing care into the home and neighborhoods through our community-based care teams and Virtual Care offerings.

In close collaboration with community-based organizations, local providers, and leading health plans, we are reorganizing the health system to focus on what matters to our members. Equipped with world-class, custom care delivery technology, we deliver personalized primary care, behavioral health, and social services to deliver a radically better experience of care for every member and community we serve.

Over the next year, we’ll grow quickly to bring better care to many more members and their communities. To do this, we need people who, like us, believe that everyone should have good care for what matters to them, in their community.

Our work is grounded in a belief in the power of a diverse community. To close gaps in care and advance equity in the communities we serve, we have to start with making our own team diverse and inclusive. Our ways of working are characterized by creativity, collaboration, and mutual learning that comes from bringing together a community from diverse backgrounds and perspectives. We strive to ensure that every person on the Cityblock team, and every Cityblock member, feels supported and included as a part of our community.

Our Values:

• Aim for Understanding
• Be All In
• Bring Your Whole Self
• Lean Into Discomfort
• Put Members First

About our Team:

We employ a field-based, home-based care model and are committed to meeting members where they are--in their homes, in their community, and in our Hubs. You will go above and beyond to connect with Cityblock members in a non-judgmental, respectful and empathic manner, to meet their needs, and to provide feedback to the system as a whole as we strive to do better every day.

About the Role:

In this role, you will provide direct services to children, some of whom face economic and social challenges in addition to having mental and physical health needs, through our innovative care model. It is integral to our care model that we meet people where they are, both physically and emotionally. Given this, your work will frequently take you out into the field and surrounding community to provide care in settings that work best for our members.

As an Advanced Practice Clinician, you will work with a panel of members to improve their health holistically through longitudinal primary care, care management, and care coordination. You will provide a necessary bridge to specialty care, homecare services, and other facility services. You will provide comprehensive care management, chronic disease management, urgent community-based primary care visits, preventative care and wellness, liaison with relevant other providers around behavioral health and long term service and support needs, and the provision of palliative care. Additionally, you will provide clinical support to our team of Community Health Partners, who will serve as member’s’ main point-of-contact and coordinator. You will work alongside, and will be supported by, a care team associated with each member, whose work is focused around a Member Action Plan (MAP).

You will:

• Follow a panel of members for primary care, and provide clinical support to the interdisciplinary care teams.
• Interface with specialists, hospitals, and community based organizations to promote an understanding of Cityblock’s model, facilitate collaboration, and promote shared decision making.
• Perform episodic urgent medical/behavioral health visits and/or telephone calls for members on your panel to ensure that timely and appropriate medical care in order to avoid emergency department visit or hospitalization.
• Perform post-discharge visits for members who have been recently discharged from either an acute care facility or skilled nursing facility to decrease risk of readmission; perform detailed medication reconciliation, and assure that appropriate long term services are in place.
• Foster lasting and trusting relationships to assist members in achieving goals, identifying new needs, and coordinating care.
• Monitor and address clinical quality gaps in care.
• Participate equally in all call responsibilities.
• Go above and beyond to connect with members and partners in a non-judgmental, respectful and empathic manner, to meet their needs, and to provide feedback to the system as a whole as we strive to do better every day.
• Work daily within our custom-built care facilitation platform, which will enable you to collect data, organize information, track tasks, and communicate with staff, members, and family. This platform is being built for a mobile workforce, and you will use our technology in the field, provide feedback to the product development team, and, over time, become part of a super-user group to assist in onboarding and supporting others.
• Attends external meetings and activities, and maintains professional credentialing and CME standards.
• Act as a mentor to other team members to help promote accountability, reliability, and independence among the other team members. Offer teaching opportunities and in-services as able.
• Assists management and leadership with the development, refinement, and enhancement of clinical programs, initiatives, processes, policies, workflows, and projects.

Requirements for the Role:

• Pediatric Nurse Practitioner PNP or Family Nurse Practitioner with licensure in good standing in North Carolina
• ANCC or AANP certification for NPs
• Three years minimum primary care experience with focus on pediatric population
• North Carolina Controlled Substance Registration
• Certified in Basic LIfe Support for Healthcare Providers
• You have experience providing clinical services to individuals with co-occurring chronic medical and behavioral health conditions, and have an interest in serving complex, vulnerable, and disabled populations.
• Proven skills, knowledge base, and judgment necessary for independent clinical decision-making.
• You are an organized, efficient, independent self-starter and problem-solver, a leader, a strategic thinker, and a mentor, who is excited about the big picture of whole community health.
• You are excited about how technology can support your work and help drive the ongoing evaluation toward new and better care.

What We’d Like From You:

• A resume and/or LinkedIn profile

Cityblock values diversity as a core tenet of the work we do and the populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

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