NP/PA, Geriatrics (Sutter Senior Care)

Sutter Health•Sacramento, CA

15h

About The Position

Sutter Medical Group is hiring Nurse Practitioners and Physician Assistants to join Sutter Senior Care, a senior-focused primary care model serving older adults with complex and changing healthcare needs throughout the Greater Sacramento area. The model emphasizes panel ownership, longitudinal relationships, proactive outreach, care coordination, and meaningful communication among care teams, patients, and caregivers rather than focusing primarily on visit volume. Advanced Practice Clinicians work closely with physicians and an interdisciplinary team to provide comprehensive medical management, promote wellness and healthy aging, and help patients navigate complex medical and social needs. The care model aims to reduce avoidable emergency department visits and hospitalizations when those interventions do not align with patients’ goals of care. The role is an outpatient Monday–Friday practice with approximately 10 pre-scheduled appointment slots daily, typically a mix of 30- and 60-minute visits. New-patient and complex visits are 60 minutes, while routine follow-ups are 30 minutes. The model incorporates same-day and next-day access and flexibility for additional same-day visits when urgent needs arise. Clinicians share accountability for a defined patient population and manage patient needs through visits, care-team collaboration, patient and caregiver communication, and proactive intervention. At full maturity, the Natomas clinic is expected to serve approximately 2,000 to 2,300 patients; one physician and two APCs would be accountable for approximately half of that population. APCs collaborate with physicians, other APCs, nurses, licensed clinical social workers, care coordinators, community health workers, clinical pharmacists, dietitians, physical and occupational therapists, and other clinical and community-based partners. Shared call is used; at full program maturity it is expected to include evenings, weekends, and holidays. The position offers an opportunity to contribute to the growth and development of Sutter Senior Care and its value-based approach to caring for older adults.

Requirements

Completion of an accredited Nurse Practitioner or Physician Assistant program.
Current applicable California licensure and national certification.
Strong clinical assessment, diagnostic, communication, documentation, and patient-engagement skills.
Ability to effectively manage chronic disease and medically complex patients.
Ability to practice successfully within an interdisciplinary, team-based environment.
Interest in caring for older adults with complex or changing healthcare needs.
Commitment to preventive care, population health, and improving outcomes for older adults.

Nice To Haves

Primary care experience in Internal Medicine, Family Medicine, or Geriatric Medicine.
Two or more years of clinical experience caring for older adults.
Experience with value-based or panel-oriented care models.
Understanding of HCC documentation, ICD-10 coding, Health Risk Assessments, and/or Comprehensive Geriatric Assessments.
Bilingual proficiency.

Responsibilities

Provide comprehensive, patient-centered primary care for older adults.
Conduct physical examinations, obtain medical histories, and complete comprehensive assessments.
Diagnose and manage acute and chronic medical conditions.
Develop and implement individualized care plans focused on prevention, chronic disease management, and healthy aging.
Develop meaningful longitudinal relationships with patients, families, and caregivers.
Take an active role in panel ownership and proactively manage changing patient needs.
Prescribe and manage medications, with particular attention to medication safety and polypharmacy.
Order and interpret diagnostic testing and laboratory results as appropriate.
Collaborate with physicians and interdisciplinary team members to coordinate comprehensive care.
Support transitions between home, hospital, specialty care, and other care settings.
Identify opportunities for proactive intervention that may prevent avoidable emergency department visits or hospitalizations.
Educate patients, families, and caregivers about disease management, medications, preventive care, nutrition, healthy aging, and self-management.
Participate in team huddles, population-health efforts, quality improvement, and initiatives designed to improve patient outcomes.
Maintain accurate and timely documentation consistent with clinical and regulatory requirements.
Support APC students or developing team members as appropriate.
Contribute to the continued development of Sutter Senior Care and its value-based approach to caring for older adults.
Participate in the shared call model, expected at full maturity to include evenings, weekends, and holidays.