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In 1990, he was again appointed the Dean of Students at Hellenic College/Holy Cross, a position he held until 1998, when he became Director of Admissions and Records. In 2000, he was named Administrative Assistant to the President of Hellenic College/Holy Cross School of Theology, Father Nicholas Triantafilou.
In December 2001, he was elected Bishop of Krateia by the [[Holy Synod]] of the Ecumenical Patriarchate. After his [[consecration of a bishop|consecration]]he was appointed by Archbishop [[Demetrios (Trakatellis) of America|Demetrios]] of America as Chief Secretary of the Holy Eparchial Synod of the Greek Orthodox Archdiocese of America. As Chief Secretary, he assisted the [[Synod]] in the promulgation and realization of its decisions.
On [[February 22]], 2005, the Holy Synod of the Ecumenical Patriarchate elected Bp. Gerasimos to be the Metropolitan of San Francisco. On [[April 2]], 2005, Metr. Gerasimos was [[enthronement|enthroned]] by His Eminence Archbishop Demetrios of America at the Ascension [[Cathedral]] in Oakland, California.
