Nurse Practitioner - Sphere Senior

About the role

As a Nurse Practitioner at Sphere Senior, you are the primary clinical presence for a panel of complex, high-needs older adults, in their homes, where they live and where care has the most impact. You'll manage chronic conditions, navigate serious illness conversations, prevent avoidable hospitalizations, and build the kind of longitudinal patient relationships that define exceptional primary care. This is a high-autonomy role, you own your panel, you drive care planning, and you make real clinical decisions. It's also a high-support role for SphereOS, your Medical Director, care coordinators, and the broader team are with you every step of the way.

Responsibilities

• Direct Patient Care
• Conduct comprehensive in-home assessments, physical exams, acute visits, and longitudinal follow-ups for a complex geriatric patient panel
• Diagnose and manage multi-morbidity with clinical precision: heart failure, COPD, diabetes, dementia, CKD, frailty syndromes, polypharmacy, and fall risk
• Develop individualized, patient-centered care plans in collaboration with patients, caregivers, and the interdisciplinary care team and actively monitor and adjust them over time
• Prescribe medications and therapies in accordance with state scope-of-practice regulations and evidence-based protocols
• Conduct advance care planning and goals-of-care conversations with sensitivity and clinical skill
• Provide serious illness and palliative care support, including symptom management and family guidance
• Care Transitions & Utilization
• Own post-hospitalization and SNF discharge follow-up to prevent avoidable readmissions, bridge visits, medication reconciliation, care plan updates
• Collaborate with care coordinators on real-time ED diversion and transition-of-care workflows
• Identify and escalate high-risk patients proactively using SphereOS risk stratification tools before crises occur
• Team & Quality
• Participate in risk stratification reviews, interdisciplinary care team huddles, and care committee meetings
• Collaborate with care coordinators, social workers, behavioral health staff, and the Medical Director on complex cases
• Contribute to quality improvement initiatives, readmission reduction, HEDIS/Stars gap closure, advance care planning rates
• Document all clinical encounters accurately and promptly within SphereOS/EHR - complete, billable, compliant
• Urgent & On-Call Support
• Respond to urgent clinical needs during shift hours in coordination with on-call protocols
• Participate in structured after-hours on-call rotation (low-burden, shared with Medical Director and APP team)

Requirements

• Required:
• Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP)
• Active, unrestricted NP license in the state(s) of practice
• National certification: ANCC (AGPCNP-BC preferred, FNP-BC accepted) or AANP (FNP-C)
• Active DEA registration (or ability to obtain prior to start)
• BLS certification; ACLS preferred
• 2+ years of NP experience in geriatrics, primary care, home-based care, SNF/LTC, or complex care management
• Demonstrated comfort with telehealth, digital health tools, and AI-assisted clinical workflows
• Strong interpersonal skills - clear communicator across varying health literacy levels
• Valid driver's license and reliable transportation (in-home travel required)
• Strongly Preferred:
• Experience in home-based primary care (HBPC), PACE, or value-based care programs
• Palliative care training or certification (ACHPN or equivalent)
• Familiarity with risk stratification tools: HCC coding, LACE index, CMS-HCC models
• Experience with ACO, MSSP, or Medicare Advantage quality programs
• Bilingual - Spanish, Mandarin, Cantonese, Vietnamese, or other languages spoken by patient communities
• Comfort working independently in field-based settings with minim

Benefits

Additional Information

Nurse Practitioner - Sphere Senior Department: Clinical Operations, Sphere Senior Reports To: Medical Director / Geriatric Care Operations Director Employment Type: Full-Time Schedule: 4 × 10-Hour or 3 × 12-Hour Shifts/Week Setting: Field-Based (In-Home) + Remote Clinical Support About Sphere Senior Sphere Senior is an AI-native, home-based primary care program built for older adults with serious, complex medical needs, people who deserve more than rushed office visits and reactive emergency care. We deliver primary care, chronic disease management, care transitions support, and serious illness/palliative care directly in the home. Our proprietary clinical intelligence platform, SphereOS, works alongside you in real time, surfacing risk flags, streamlining documentation, tracking care gaps, and keeping the full care team coordinated. You'll practice at the top of your license, supported by technology that actually reduces your cognitive load instead of adding to it. You won't be doing this alone. You'll have a supervising Medical Director, a dedicated interdisciplinary team, and a care infrastructure designed so you can focus on what you do best: caring for patients.

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