Nurse Practitioner

At Blue Ridge Care
, we deliver extraordinary care to improve life's journey. As a mission-driven, not-for-profit healthcare system, we provide integrated services in hospice, serious illness care, the Program of All-Inclusive Care for the Elderly (PACE), community thrift shops, and grief support. Our goal is simple: to reimagine how communities experience aging, serious illness, and end-of-life care through compassionate, personalized, high-quality care.

We are seeking a dedicated Nurse Practitioner (NP) to join our PACE team and provide comprehensive, participant-centered primary care to frail older adults. This role offers the opportunity to work collaboratively within an interdisciplinary team while helping participants maintain independence, improve quality of life, and remain safely in their communities.

Under the supervision of the Medical Director, the Nurse Practitioner provides primary care services to PACE participants, including comprehensive assessments, ongoing evaluations, diagnosis and treatment of acute and chronic conditions, participant education, and care coordination. The Nurse Practitioner serves as an active member of the Interdisciplinary Team (IDT) and plays a key role in developing and implementing individualized plans of care for medically complex older adults.

• Conduct comprehensive history and physical assessments for new PACE participants.

• Perform semi-annual and as-needed reassessments and update care plans accordingly.

• Evaluate, diagnose, and treat acute illnesses and changes in participant condition.

• Develop and implement individualized care plans in collaboration with the IDT.

• Coordinate referrals to specialists and other healthcare providers as needed.

• Provide education and health coaching to participants, caregivers, and families.

• Coordinate participant care across healthcare settings and community providers.

• Ensure accurate, timely clinical documentation and diagnostic coding.

• Participate actively in Interdisciplinary Team meetings.

• Provide clinical recommendations and support coordinated care planning.

• Serve as a geriatric care resource for team members.

• Collaborate with physicians and other healthcare professionals to support participant outcomes.

• Support quality improvement initiatives and best-practice standards.

• Review records and documentation to ensure regulatory compliance.

• Educate staff regarding the specialized needs of frail older adults.

• Adhere to PACE regulations, organizational policies, and professional standards.

• Maintain participant confidentiality and uphold all safety and infection prevention guidelines.

• Participate in an established on-call rotation.

• Provide clinical guidance and support during evenings, weekends, and holidays as assigned.

• Respond appropriately to after-hours participant needs and coordinate escalation of care when necessary.

• Graduate of an accredited School of Nursing.

• Current Registered Nurse (RN) license.

• Graduate of an accredited Nurse Practitioner program.

• Current Nurse Practitioner license.

• National Nurse Practitioner certification.

• Current CPR/BLS certification.

• Valid driver's license, reliable transportation, and proof of insurance.

• Geriatric Nurse Practitioner (GNP) certification with prescriptive authority.

• Experience working in a PACE program or integrated care model.

• Knowledge of PACE regulations and geriatric care best practices.

• Minimum of two (2) years working with frail elderly or medically complex adult populations.

• Two (2) years of Nurse Practitioner experience in geriatrics…