Nurse Practitioner - ElderONE

Rochester Regional Health; City of Rochester (NY); On-site; USD 100,000 - 150,000; Full time

Job summary

Rochester Regional Health's ElderONE program seeks a Nurse Practitioner to deliver comprehensive geriatric care through an integrated, home-and-community based model. You will work within an interdisciplinary team to develop individualized plans that support aging in place and maintain participants' independence.

Daily responsibilities include clinical assessments, care management, care transitions, and coordination with primary care, home care, and extended care services across multiple sites.

Qualifications

• MS in Nursing required; NY NP license preferred.
• Active NP certification and NY RN license.
• Experience with geriatrics or PACE settings preferred.
• Epic EMR experience preferred.

Responsibilities

• Clinical care: evaluate and manage acute, sub-acute, and chronic needs of older adults with an interdisciplinary team.
• Care management: comprehensive reviews of chronic conditions and goals of care.
• Interdisciplinary admin duties: attend daily meetings, review labs, and support care transitions.
• PACE & community-based care: support 800+ ElderONE participants across sites and homes.
• Program growth: collaborate on quality improvement and care delivery innovations.
• Infection control: follow guidelines to minimize exposure and risks.

Skills

Nurse Practitioner

Care coordination

Interdisciplinary teamwork

Problem solving

Communication skills

Education

MS in Nursing

Tools

Epic EMR

Job description

Summary

Join ElderONE, Rochester Regional Health's comprehensive PACE (Program of All-Inclusive Care for the Elderly) program, providing integrated, person-centered care to older adults with complex medical, functional, and social needs. This Nurse Practitioner role offers the opportunity to make a meaningful impact by helping participants remain safely in their homes and communities while collaborating within a highly engaged interdisciplinary care team.

Status

Full Time

Location

ElderONE

Department

Geriatrics

Schedule

Days; Monday-Friday, 8:00 AM-4:30 PM

Attributes

• Passion for serving older adults and supporting nursing home eligible individuals to remain safely in the community
• Experience working with older adults and/or medically complex patient populations preferred
• Experience in PACE, Primary Care, Long-Term Care, Home Care, Geriatrics, or community-based care settings preferred
• Knowledge of care coordination, value-based care, and interdisciplinary team-based care preferred
• Strong problem-solving, organizational, and relationship-building skills
• Epic experience preferred; PACE experience a plus

Responsibilities

• Clinical Care. Evaluate and manage acute, sub-acute, and chronic clinical needs of older adults. Collaborate with physicians and interdisciplinary team members to develop individualized treatment plans that align with participant goals, functional status, and quality of life.
• Care Management. Complete comprehensive clinical reviews of chronic conditions and document in the medical record. Assess and reassess participant-specific goals of care while reviewing specialty recommendations and coordinating appropriate follow-up care.
• Interdisciplinary Team Administrative Duties. Attend daily interdisciplinary team meetings and care planning conferences. Review laboratory results, specialty notes, and diagnostic testing, initiating orders when appropriate. Complete pre-enrollment visits and support care transitions and discharge planning activities.
• PACE & Community-Based Care. Support approximately 800+ ElderONE participants across multiple community-based sites and home settings. Partner closely with Primary Care, Home Care, Extended Care, and other system services to provide coordinated, person-centered care for a complex older adult population.
• Program Growth & Collaboration. Contribute to a growing and evolving PACE program through interdisciplinary collaboration, quality improvement efforts, process enhancements, and innovative approaches to care delivery.
• Infection Control. Utilize infection control equipment and safety guidelines to minimize and prevent exposure to communicable diseases, infectious body fluids, and risks associated with patient treatment.

Education

MS: Nursing (Required)

Licenses / Certifications

NP - Nurse Practitioner Certification - NYS Office of Professions, RN - Registered Nurse - NYS Office of Professions

Physical Requirements

Moderate - Clinical - Moderate clinical roles are patient facing roles that require continual movement, including standing, walking, and lifting 20–50 lbs., along with pushing and pulling medical equipment and assisting with patient positioning. Employees perform frequent bending, twisting, and reaching while completing fine motor tasks in busy or confined clinical environments. High sensory acuity is essential for monitoring patient status and responding to alarms or safety concerns. Emotional and cognitive demands are substantial, involving decision‑making under pressure, responding to emergencies, and maintaining sustained focus. Environmental exposures include infectious agents, bodily fluids, chemicals, and radiation. TB testing, mask‑fit testing, and physical exams are common requirements.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

Pay Range

$100,000.00 - $150,000.00

City

Rochester

Postal Code

14617

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.