NP/PA, Geriatrics (Sutter Senior Care)

Sutter Medical Group (SMG) is seeking Advanced Practice Clinicians (APCs), 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. Sutter Senior Care is designed around a different approach to primary care for older adults. Rather than focusing primarily on visit volume, the model emphasizes panel ownership, longitudinal relationships, proactive outreach, care coordination, and meaningful touchpoints between the care team, patients, and caregivers. As an APC, you will partner closely with physicians and an interdisciplinary team to provide comprehensive medical management, promote wellness, support healthy aging, and help patients navigate complex medical and social needs. The model is designed to reduce avoidable emergency department visits and hospitalizations when those interventions do not align with the patient's goals of care. This is an opportunity to join Sutter Senior Care during an important stage of its growth and help shape a different kind of primary care experience for older adults.

Effective senior care extends beyond the number of patients seen in the clinic each day. Sutter Senior Care creates the flexibility for clinicians to respond to changing patient needs and proactively manage a defined patient population.Practice highlights include:

• Monday-Friday outpatient practice
• Approximately 10 pre-scheduled appointment slots per day, with a mix of 30- and 60-minute visits
• 60-minute new-patient and complex visits
• 30-minute routine follow-up visits
• Flexibility to accommodate additional same-day visits when urgent patient needs arise
• Same-day and next-day access incorporated into the care model
• Interdisciplinary, team-based approach to complex senior care
• Focus on prevention, chronic disease management, medication safety, care transitions, and quality of life
• Opportunity to help develop and shape a growing senior-focused service line

Sutter Senior Care is structured around shared accountability for a patient population, rather than a traditional visit-volume model.At full maturity, the Natomas clinic is expected to serve approximately 2,000 to 2,300 patients. A care team consisting of one 1.0 FTE physician and two 1.0 FTE APCs would be accountable for approximately half of the clinic's patient population.This approach requires clinicians who are comfortable thinking beyond individual encounters and actively managing the health of their patient panel through office visits, care-team collaboration, patient and caregiver communication, and proactive intervention as needs change.APCs work collaboratively with an interdisciplinary team designed to include:

• Physicians
• Other APCs
• Nurses
• Licensed Clinical Social Workers
• Care coordinators
• Community health workers
• Clinical pharmacists
• Dietitians
• Physical and occupational therapists
• Other clinical and community-based partners

The team structure is intended to address both the medical and social factors affecting a patient's health while supporting coordinated care throughout the aging journey.

• →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 the proactive management of 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
• →Help identify opportunities for proactive intervention that may prevent avoidable emergency department visits or hospitalizations
• →Educate patients, families, and caregivers regarding 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

Sutter Senior Care uses a shared call model. As the program reaches full maturity, shared call is expected to include evenings, weekends, and holidays.

We are looking for APCs who want to practice relationship-centered, panel-based primary care and who understand that excellent care for older adults often happens beyond a traditional office visit.The ideal candidate enjoys building long-term relationships with older adults and their families and is comfortable managing patients with multiple chronic conditions and complex medical, functional, and social needs.Candidates should value flexibility, proactive patient management, shared decision-making, and interdisciplinary collaboration. They should be comfortable assuming meaningful responsibility for a patient population while partnering closely with physicians, other APCs, nurses, social workers, pharmacists, care coordinators, and other members of the care team.

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

 

• Excellent benefits, including zero-cost medical insurance
• Paid medical benefits for employees and dependents
• Award-winning, 100% 401(k) match
• Relocation assistance up to $20,000
• CME allowance
• Robust retirement program
• Advanced practice technology, including EPIC
• A positive work-life balance and Northern California's natural beauty and lifestyle

Sutter Medical Group (SMG) is a vibrant and talented community committed to delivering safe, affordable and high-quality care. Our multi-specialty medical group is comprised of over 1,600 clinicians practicing in seven counties in northern California, most within a 50-mile radius of Sacramento. SMG contains primary care and specialty Physicians and Advanced Practice Clinicians -- nurse practitioners, physician assistants, certified nurse midwives, licensed clinical social workers and licensed marriage and family therapists, who make up about 20% of our group. Our clinicians not only excel in clinical practice but are also actively engaged in teaching, research, leadership, community outreach, and volunteer work. SMG has earned both local and national recognition for excellence in patient care and experience.

Caring for medically complex older adults requires time, continuity, flexibility, and teamwork.Sutter Senior Care is being developed around those realities. Instead of defining success solely by the number of office visits completed, the model creates room for longer appointments, urgent same-day needs, proactive patient and caregiver touchpoints, interdisciplinary collaboration, and shared responsibility for a defined patient population.For APCs who want to know their patients, manage the whole person, partner with families and caregivers, and intervene proactively as needs change, Sutter Senior Care offers the opportunity to help build a different kind of primary care practice within Sutter Health.

It is the policy of Sutter Health and its partners to provide equal employment for all qualified individuals; to prohibit discrimination in employment because of basis of race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state or federal law, ordinance or regulation. We promote the full realization of equal employment opportunities through a positive continuing program within each medical group, company, hospital, department, and service area. Equal employment opportunities apply to every aspect of Sutter's employment policies and practices.