nurse practitioner

bilingual call center representative

medical assistant

call center representative

certified medical assistant

Transtreme, LLC

I’m a current employee who has been working with Transtreme over the last 4 months.   My experience has been overwhelmingly positive thus far. 

My interview took place of the course of 3 dinner meetings after the initial phone screening.  I can honestly say it was the most fun and I’ve had interviewing for a company.  The meetings were informal and relaxed in a causal atmosphere.  I first met with the CEO and Vice President and one of the managers over dinner, the next interview was with leadership members in finance and software development.  For our Nurse Practitioner candidate’s, interviews are conducted in a similar way- a phone screening, in person meeting and we also offer the opportunity to shadow our current practitioners while conducting patient encounters so they can get a feel of the day to day workflow and care delivery settings. 

As far as compensation, I am very pleased with my package.  Being an independent contractor allows me to write off expenses for my home office, transportation, phone costs, meals while traveling and many other costs incurred while conducting business; substantially reducing my tax burden.  When negotiating my pay, the leadership team increased my hourly rate to account for benefits (health insurance, 401k, vacation pay, etc) that I previously had while in a w2 role.  I prefer this model as it gives me control over where I want to invest my earnings as far as benefits are concerned.

The company culture is a huge benefit of working with Transtreme.  My previous role was in a very corporate and competitive environment, so being a part of the team here is much less stressful, a breath of fresh air.  I’ve not experienced any micromanagement; team members are trusted to complete their work and goals with minimal supervision.  The leadership team empowers us to identify and utilize our strengths to best serve our clients and patients.  Coaching and education is provided by leadership and team members are encouraged to provide constructive feedback and ideas that could help improve business process and care delivery. Opportunities to work remote or from home exist when viable depending on the role and needs of the client. 

Another one of my favorite things is being a part of a company that is truly making a positive impact for our clients and patients.  We see many thousands of patients per year and it’s great to know I am contributing to a program that is saving lives, improving patient outcomes and helping at risk populations better manage their health conditions.  There are also travel opportunities as we continue to grow and serve our current client base and partners throughout Northern and Southern California, Hawaii, Nevada, etc.  It’s easy to stay motivated every day when you know that you are a part of something special that’s making a positive impact on so many lives.  

Additionally, there are many growth opportunities for team members to become team leaders as we continue to grow and expand into new markets.

I had been working for Transtreme for 2 1/2 months when a personal situation came about. I spoke with Rick, the CEO/Founder/NP as well as our CFO and lead NP. They could hear the panic in my voice. They gave me feedback, insight and most of all...compassion. At the end of it all, they reassured me and came out with a plan, that put me at ease and relieved the panic. I have been working as a NP for 25 years, both in large group practices and small. I have never been treated so kindly and compassionately in all my career. They had my back. They treated me as if I had been a long term employee, when in fact I was only on their payroll for 2 1/2 mos.   In terms of the work load.....It is different than the typical responsibilities that one may be accustomed to. You don't treat the patient or write prescriptions. You never need to call patients. You do a basic head to toe assessment, review their chart, perform neuropathy and vascular testing, as well as spirometry testing.  You code their diagnoses. You make recommendations to their PCP. I don't come home stressed! You work at different clinics everyday, however towards the end of the fiscal year, you will be doing home visits. You see 8 patient's/day, one hour per visit. There is autonomy. The company is now slowly expanding to perform limited pediatric and women’s health care.   You don't encounter the typical bureaucracy/drama/conflict that is encountered from traditional NP work. The type of work  was previously a contract/1099 position.  However, as of January 2020, it became a W2 position. There is work year round, so you don't have to worry that there will be "down time", compared to competitor companies. The hourly wage is at the top of the scale and nothing to sneeze at. There is flexibility in your schedule, therefore excellent work/life balance.  I have now been with the company two years, and I continue to feel professionally dedicated, appreciated, and content on many levels.   Something I have  not felt In quite sometime, in my 25 years working as an NP.  The only con I can see with the position, is that your skills may diminish as an NP, since you will not be treating the patient or writing prescriptions for the patient. However, for some, that may be a positive. 😀

Benefits are bare minimum. They held a town hall meeting and took the suggestions of employees out of context. If you’re in a state as a w2 employee, you can expect only 3 sick days, a minimal amount of PTO accrued, and a government suggested program for employers to provide a Roth IRA and NOT a 401k (big difference) with no matching. No paid holidays as we were told it’s not a requirement and is considered a privilege.  Also, they don’t contribute much towards health plans.  It’s still very expensive. 

Transtreme is an outside vendor that relies on contracts for business. Just in case the contract ends (which some do) in a specific market you will get moved frequently.  A large contract just ended so they’re trying to get new contracts to shift nurses and schedulers around.

Everything is micromanaged even down to your time card.  Two executives literally go through each and every employee’s time card to approve it.  No time clock on the wall to clock in.  There’s a system they created to clock in for schedulers but it’s time consuming and glitchy.  Also, they have a ring camera system hooked up to their phones and watches so they can see when employees go in and out. 

On the topic of raises, during your interview ask when they actually started the performance reviews to give raises. 

The words “financially”, “budget”, and “money” are mentioned frequently.  I suggest in order to retain employees, less negative talk about financial decisions and more focus on how to keep their employees happy.  If an employer invests in programs that are competitive with organizations, the more motivated employees will be.  

If you’re a nurse, the leads are fairly easy to work with. They hire new grad nurses because they’re easy to “mold” (a term they use a lot). They unfortunately lose NP skills so if you’re ready to get out of a clinic setting for something that doesn’t require a lot of critical thinking, then this is your place.  

Working as a Nurse Practitioner with Transtreme has been a beautiful addition to my life. As a wife and a mom of three small boys, I appreciate so many things the company has to offer. The flexibility of my schedule allows me to still be present in my family life while working full time. Before I was hired, I was able to meet with the CEO and the NP who would be training me, they were both so personable, kind, and passionate about the company as well as the patients. This is why I chose transtreme over my other 4 job offers! I Thank God everyday for this team, not to mention all the other people on the team who immediately answer my questions and e-mails when I need them. I would say my favorite part of working for this company is how everyone I work with feels like family, including medical assistants, leaders, and other practitioners. 

One hour visits: As far as the work goes I get to spend an entire hour with each patient. This has created a wonderful relationship because the patients feel valued and seen. I also get to investigate their needs because I have the time to do so. Almost every patients leaves saying they are very thankful for the visit and feel that they have learned a lot about their health. 

Last thing to mention is the resources provided by the company. Everything you will need to know or have questions about upon hire can be found through the employee website. This has been extremely helpful, especially for new hires who want to learn at their own pace and access resources anytime they need. 

This job is completely stress free!!! I have learned so much already working with this team and I look forward to many more years as an employee!

Recent employee with Transtreme. If you are looking for flexibility, which is a positive for this company, and do not mind the subpar benefits, state minimum sick pay (3 days), 2-3 days of vacation (for fulltime employees) and below average pay, then this might be the company for you. Another important factor to consider is that these benefits and pay do not change much even if living in a big city versus a more rural environment.

As an NP, you will not be prescribing medications or diagnosing. You will not be conducting procedures and so if you are a new graduate NP and these factors interest you, it may be hindering your growth as an NP. You do have the opportunity to meet a large number of physicians and their staff as you will likely work out of their practices. The culture is fantastic and rivals many of the big hospitals in California. They do, however, stay true to their word of 1 patient per hour.

The most difficult part of the job in my opinion is interacting with management and dealing with a certain degree of micromanagement, depending on who your direct NP lead. Another difficult element to digest is pay and benefits, however, for the relatively low risk of lawsuit, it is difficult to justify arguing for the same rate as an NP in a clinic who does double or sometimes triple the amount of work that a Transtreme NP does in a typical day. 

If a slow pace, low stress job is on your radar, Transtreme may be for you. If you are a new graduate and have aspirations of someday being a clinic NP and doing procedures, it it might be a good idea to rethink prospective employment with this company.

I see patients in various settings, including patients' homes, one of our wellness centers, at doctor's clinics, or via telehealth visits. I like that there is variety in how I see my patients. I am grateful that this is a much less stressful job compared to my previous job at a FQHC. My husband points out that I do not appear drained or frustrated when I get home from work like I used to; and I get home at a decent time to enjoy dinner with my family and spend some time with my kids before their bedtime. I see an average of one patient per hour, which means I can take more time with them to complete a thorough assessment, provide adequate patient education, and answer questions they have. Patients appreciate that I take the time to listen, educate, and perform screenings on them, including checking for peripheral vascular disease and peripheral neuropathy. Prior to the coronavirus pandemic, spirometry to check for COPD was included. I love the flexibility in my schedule. I pick which days I want to work each month and submit my schedule 1-2 months in advance. If I want to take a day off or a vacation, I just put myself off for those days. If something comes up or I am not feeling well, it is very easy to contact my NP lead to accommodate without making me feel guilty. Support staff, colleagues, and leadership are all very nice and responsive. Relevant company information and updates are communicated to us regularly, which is great. We also get recognition for our hard work and flexibility on a regular basis.

Unfortunately employee retention is not valued here. The type of leadership on all levels is micromanagement to meet quotas. The company agrees to take on too much by “expanding”, and the laborious work trickles down the hierarchy which has staff working tirelessly without proper compensation.  Staff is enticed by offering an additional bonus to the hourly rate (specially NPs) to take on extra work because of the pandemic.  From a management perspective, that money should be considered for providing raises to staff to help retain them.  Instead it’s all about the numbers and his clients, while the value of employees is diluted in healthcare politics.  At one point, schedulers were allowed to rotate working in the office and home until “proficiency had plummeted.  We’re in a pandemic and the Medicare population is uncomfortable with going into a clinic or having NPs come to the home which affects the numbers.  For NPs and MAs, you will lose your clinical skills.  The work is mainly focused on being a coder.  

There is no PTO, no paid holidays, no 401k, no overtime (even though you work OT), only 3 days of sick days a year that does not accrue (you have to use it or you lose it), cameras with audio all over the offices to make sure you’re working you, no microwave in the office, staff are forced to move all over the company, staff is not provided proper PPE when face to face with clients, no reimbursement for cell phone minutes/data despite heavy cell phone usage, and no reimbursement for CEUs.  If you get COVID at work, you don’t get paid for that. 

I worked here for a very brief stint. It was intentionally brief because I saw the red flags right away.  The hiring process wasn’t bad. Onboarding in the field was a nightmare. I’m not sure how this program does well in the Reno area because the NPs are very difficult to work with. Each NP wants things done a certain way. In order for something like this to succeed, there has to be only one consistent way of doing things to eliminate confusion and frustration. It seems like these NPs are stuck in their ways and I’m surprised they haven’t been reprimanded for their behaviors. There will continue to be a high turnover rate if this is not corrected.

Not to mention it’s almost impossible to chart in between patients because you are driving for very long periods of time between patients. You end up having to chart at home which is not ideal for me.  I don’t think it’s ideal for any nurse. 

There is no work life balance. A recommendation to management and ownership, work is not life and life is not work.  I know you take pride in traveling all over the place to open new markets, but life isn’t all about working.  Treat your employees fairly and live life outside of work to the fullest. Employees shouldn’t have to feel they need to take their work home.

I wish them well and the hope in the future they make appropriate changes, because if  not unfortunately it’ll just continue to decline in the future.

One patient per hour which is good for patient education. Lots of documentation with the job but that's more of a CMS/Medicare requirement than the company, so the company cannot control that. Can be difficult to perform chart reviews, conduct the patient visit, perform screenings, and complete extensive documentation in the hour so there are times you have to take work home.  Changes in health plan clients within the last year served has lead to less work, especially towards the end of the year, more home-based model of care instead of clinic-based. Work is not guaranteed, so prepare for days of staying at home with no patients to see, especially towards the end of the year. Workplace culture is mostly virtual since you are assigned to a particular clinic or doing home visits, so the ability to work autonomously is a must. Most enjoyable part of the job is self-scheduling, but you don't get paid for work not performed, and PTO and Sick leave accrual is minimal at best.

The qualifications to work at this company have deteriorated, no longer do you have to have ANY medical background, only customer service is required. Sad when one works with PC providers,  quality of personnel as far as NP's is outstanding, MA 's (so called) lack professional appearance, no telephone etiquette and or training. Some can not even explain the preventative screeing assessments or what the functionality for them are. Main function is scheduling patients using your own personal cell phone and blocking call so patients are skeptical about either answering or scheduling. The company has grown indeed, but it's grown out of control to the point where "schedulers " are prompted to strong arm patients into next day appointments to meet PCP percentage quarterly quotas. It is a family based business, that has lost focus on what they initially offered the PCP's when agreeing to work with their patients. It's growth and the opportunity to make more $ has changed this company to one that conveyed the concerns of patients to their PCP's to one that is solely focused on increased profit.  As far as company employee interactions the (dinners/picnics) it's easier to pay for an outting of that nature than promotions/wage increases plus it's a tax write off.

Top Job Titles	Average Salary
Nurse practitioner 12 salaries reported	$154,583 per year
Bilingual call center representative 4 salaries reported	$18.50 per hour
Medical assistant 1 salary reported	$21.00 per hour
Call center representative 14 salaries reported	$16.07 per hour
Certified medical assistant 3 salaries reported	$17.00 per hour

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