We use data infrastructure to enable more timely and personalized engagement with individuals living with SMI at scale. This allows our team of peers, social workers, and nurse practitioners to plan appropriate care and focus on critical tasks rather than manually searching for information across silos in the healthcare system. This is a unique opportunity to help drive the impact and capabilities of our data team and infrastructure. You will build impactful healthcare technology on a modern technology stack.

This is a remote, individual contributor role reporting directly to the CTO. You'll be the most senior data engineer on a team of 3 (within a 5-person engineering department). This is a technical leadership role - no people management, but broad ownership, autonomy and responsibility to : define and drive excellence in our data platform. 

Our data infrastructure is built on Snowflake, DBT (Cloud), Airflow, and Python, with tools like Fivetran and Hightouch. The foundation is solid but not pristine - there's a solid mix of improvements to handle, new features to enable, and running-the-business systems to improve and automate.

Role expectations:

• Responsible for designing, building, and optimizing scaled data infrastructure, serving as a technical lead and mentor within the organization. 
• Directly collaborate with cross-functional stakeholders to effectively gather requirements and understand business needs in order to create durable pipelines, infrastructure, and ELT models that enable the company to ingest data in various formats and from various sources and then turn them into usable business facing data products. 
• Align and coordinate your team's work against strategic business priorities and help define and manage the data roadmap.
• Drive operational excellence by ensuring data quality through automated testing and validation, robust pipeline monitoring and alerting, and establishing clear incident response practices when things break.
• Provide technical leadership through mentorship, architecture reviews, and maintaining high technical standards across the codebase.
• Own data architecture, infrastructure, and platform improvements. Drive systems improvements and upgrades with a long-term view.
• Use systems thinking to solve problems and add capabilities. Adopt tools, technologies, and patterns to provide leverage. Build a platform, don't just get tasks done.

The experience you bring to this role:

• 7+ years of data engineering experience, with deep expertise in technologies like Snowflake, DBT, Airflow, and Python. You've architected data systems for reliability and scale, not just built pipelines to spec.
• A track record with ambiguous initiatives that required breaking down complex problems, coordinating across engineering and business teams, and delivering outcomes.
• Strong technical communication skills, including the ability to represent your team's work and direction to non-technical leadership, and to translate business needs into technical strategy that others can follow.
• Experience enabling team leverage through mentorship, establishing technical standards, and guiding stakeholders through capability tradeoffs; you make the people and systems around you better.

Bonus:

• Familiarity with healthcare data: claims, pharmacy data, interoperability specs (HL7/FHIR, X12, etc) is at the core of what we do.

The Triage Nurse is a remote Registered Nurse who provides telephone and electronic triage support to firsthand individuals and staff, while also supporting outpatient care coordination. This is primarily a day-shift role (8 hours/day, 8:30–4:30 PST), with occasional potential for nights or weekends. When not managing acute issues, Triage Nurses focus on care coordination, training, and related administrative tasks.

Responsibilities of a Triage Nurse include:

• Triage and Escalation: Manage inbound clinical issues from firsthand staff and patients via phone; triage appropriately and escalate emergencies immediately.
• Collaboration: Work closely with peer mental health workers, social workers, and APPs to address acute issues comprehensively.
• Coordination: Coordinate care with patients’ other providers to ensure seamless health management.
• Training: Develop and deliver training on basic medical topics for peer mental health workers and social workers.

Triage Nurses should have:

• Strong triage and prioritization skills, with the ability to rapidly assess and determine the appropriate level of care.
• Problem-solving expertise with a creative, patient-centered approach.
• Ability to provide condition-specific patient education and self-management guidance.
• Adaptability to varying team cultures and processes.
• Empathy, compassion, and approachability in patient and team interactions.

Required experience includes:

• Active RN license through a Nurse Licensure Compact (NLC) state and willingness to obtain licensure in non-compact states.
• Bachelor of Science in Nursing (BSN) or Associates of Nursing (ASN)
• At least 3 years clinical care experience in psychiatric inpatient or outpatient settings AND/OR at least 3 years of Emergency Room (ER) experience 
• Experience working with populations facing challenges such as serious mental illness, behavioral health conditions, and/or substance use disorders
• Care management and coordination experience.

Bonus Points for:

• Psychiatric-Mental Health Nursing Certification (PMH-BC)
• Washington state RN license

Senior Psychiatric Nurse Practitioner (Remote)

The Psychiatric Nurse Practitioner is a licensed Nurse Practitioner certified in  Psychiatric Mental Health Nursing, who leads the behavioral health aspects of virtual care for individuals with serious mental illness (SMI) that firsthand serves. At firsthand, our NPs are referred to as Health Guides (HGs), as they are dedicated, compassionate advocates, leading our individuals on a journey towards wellbeing and recovery.

The Psychiatric Nurse Practitioner HG is responsible for virtual behavioral health assessments, management of our vulnerable population, and collaborating closely with community providers. The Psychiatric Nurse Practitioner HG serves as a key member of the shared clinical services team which includes triage and care coordination nurses (TCCNs) and nurse practitioners (HG flex).

• As a Psychiatric Nurse Practitioner, you will perform Medical and Behavioral Health assessments, including:
• Provide exemplary customer service to individuals with SMI and maintain a NPS score of 90% or higher
• Commitment to reducing avoidable Psychiatric ER visits through timely evaluation and interaction with individual
• Assess behavioral health and medical conditions with a thorough history and virtual physical examination
• suicide stabilization,  diagnosis and stabilization of bipolar, schizoaffective, and schizophrenia in a fully remote environment with in-person peer recovery support.
• Diagnose psychiatric disorders and mental health conditions
• Document patients’ medical and psychological histories, mental status exams, diagnoses, treatment plans, prescriptions, and outcomes
• Educate patients and family members about mental health, medications, and treatment plans
• Prescribe and monitor prescribed prescriptions for psychotropic medications, abiding by laws and regulations
• Manage and monitoring for metabolic syndrome and/or other comorbidities 
• Collaborate with a team of support including licensed and non-licensed professionals
• Ensure continuity of care,  referring  to community primary and behavioral health providers and specialists based on assessed needs
• Support individuals in developing and exercising self management skills and skills skills person-centered care around their individual goals and preferences via motivational interviewing and holistic care planning

Performs virtual SOAR (SSDI/SSI Outreach Access and Recovery) disability assessments, including:

• Highly detailed intake visit on patient’s behavioral health history and impact on ability to work 
• Organizing the information in a manner that supports appropriate clinical documentation and successful disability applications (if appropriate)

Provide Guidance and Support to Psychiatric Nurse Practitioners

• Lead by example in maintaining above average visit productivity levels
• Display a positive attitude and team player mentality within team
• New hire on-boarding and shadowing, and other responsibilities as assigned by Director of Shared Clinical Services
• May be responsible for player-coach mentorship of Primary Care/Psychiatric Nurse Practitioners or Triage Nurses (Does not include hiring/career decisions, personnel management.)
• Assist with developing and implementing new Primary Care/Psychiatric Nurse Practitioners interventions and work processes
• Assist with training and coaching Health Guides and Flex Health Guides on diagnosis and management of psychiatric disorders

You will be a good fit if you have:

• Intrinsic motivation to be a top performer in visit productivity and patient outcomes
• Tenacious self-starter and independent thinker
• Above average comfort with technology, as this is a 100% remote position
• Desire to perform data driven care
• Natural ability to adapt to various assignments and moving target goals
• Empathy, compassion, and approachability 
• Excellent listening, communication, and interpersonal skills
• Ability to maintain professional boundaries and engagement skills with a population with challenges and in non-traditional work conditions

The experience you bring to this role includes:

• certification as a Family Nurse Practitioner/Psychiatric Mental Health Nurse Practitioner or Adult Health Nurse Practitioner/Psychiatric Mental Health Practitioner.
• 3+ years clinical care as a Psychiatric Mental Health Nurse Practitioner or Adult Health Nurse Practitioner/Psychiatric Mental Health Practitioner.
• Telehealth experience 
• Ability to work collaboratively with a diverse group of licensed and non-licensed professionals
• Strong background in the diagnosis of psychiatric disorders and psychopharmacological treatments and familiarity with non-pharmacological interventions
• Excellent verbal and written communication, organizational, and time management skills

firsthand is building a workplace and culture that cares deeply for our team and our communities. Our benefit design is in line with our values of compassion and empathy:

• A range of healthcare benefits offerings for yourself and/or your family
• 401(k) with employer matching program
• Competitive and flexible paid time off policies
• Choice of Mac or PC for laptop or tablet as needed

Who We Are

firsthand is changing the way individuals living with Serious Mental Illness (SMI) get care. We are focusing on delivering real outcomes for a cohort that has historically been underserved, stigmatized, and deprioritized. By building a service focused on whole-person care, firsthand aims to find, establish a trusting relationship with, and support quality care for individuals living with complex experiences of SMI. firsthand’s high-touch model will dramatically improve the health and outcomes of its engaged individuals, driving down the utilization of high-cost care while also helping individuals enroll in eligible federal, state, and municipal benefits. Most importantly, our goal is to be the trusted guide, partner, and first call for individuals we serve, guiding them to a life of stability and independence.

In doing so, we will not only improve lives, but also improve the economics for managed care plans and states responsible for providing care to this community. This enables us to build solutions that scale and, as a result, change the way our society supports those most impacted by serious mental illness.

We are building a team of deeply passionate problem-solvers who are courageous enough to take on one of the country’s most challenging healthcare problems. Those who are up for the task will be rewarded with deeply mission-oriented workdays, mentorship from a similarly motivated team, and a voice at the table in the earliest stages of business building.

Position Overview

The Vice President, Central Operations is a high-impact, mission driven leader responsible for the design, implementation, and operational and clinical performance of the firsthand care model across our centralized services. The role will be a significant contributor to designing, implementing and leading our central care teams, which includes multiple service lines serving all of our markets across the country. 

Specifically, this leader will lead all shared services today – with significant room to change and evolve as firsthand grows and evolves. To start, this will include our Support Operations (billing, coding, benefits support, medical records, and clinical documentation integrity), our Central Operations (which includes our virtual outreach and engagement teams), while also leading the design, development and execution of multiple new national service lines, such as 24/7 triage, centralized consult services, and more. 

Job Specifics

As VP, Central Operations, your responsibilities will include: 

• Lead the strategy, performance and execution of all centralized operational functions to enable our care model performance, as well as our multi-market expansion
• Establish KPIs, dashboards, and performance framework to drive strong processes with operational visibility across the company and our community operations 
• Design multiple new processes that will launch at a national scale across engagement and care model; will lead the process through from design/ideation to implementation to ongoing execution and oversight 
• Lead the operational strategy and execution of multiple value drivers across our business (such as benefits support & accurate clinical documentation), as well as as HEDIs and total cost of care interventions 
• Report directly to the COO and partner with a clinical dyad partner (Sr. Director of Central Clinical Programs), while meaningfully collaborating with community operators and support teams across the org 
• Lead, mentor and actively develop leaders across the central operations team, as well as acting as an informal leader and partner to leaders in community operations 
• Galvanize and foster a high-performing, inclusive, and supportive employee culture, driven by and visibly embodying the firsthand values

The experience you bring to this role includes:

• Significant experience (7-10+ years) in healthcare leadership roles, preferably in a high-growth, high-complexity organization with rapid scale
• Deep understanding of value based economics and operations to ensure our centralized processes deliver value across multiple risk-bearing contracts 
• Experience leading in a clinical-operational dyad model
• Proven track record designing and scaling new clinical and operational processes, preferably in a start-up environment 
• Deep understanding of value-based care, Medicaid, and the behavioral health ecosystem (SMI/SUD)
• Exceptional leadership presence, executive communication skills, and the ability to inspire and manage large, cross-functional teams
• A passion for serving individuals living with SMI