The RN Case Manager will be part of a multi-disciplinary team providing home care to a diverse caseload. This Community Health RN/Visiting Nurse#position provides comprehensive nursing services to individuals and families in the community.# RN utilizes the nursing process in planning, providing#and evaluating skilled nursing care to individuals and families. RN performs a comprehensive nursing assessment#including physiological, psychological and environmental factors. RN develops, evaluates, and revises patient care goals in conjunction with the patient and family. RN coordinates goal directed, cost effective care for#primary patients and demonstrates appropriate use of community resources#to deliver comprehensive individualized care. RN communicates with MD, family and interdisciplinary##care providers to clarify care and increase awareness of significant#changes in condition in a timely manner RN maintains effective working relationships with#patients/families, referral sources, physicians, community resources and#insurance representatives RN provides adequate education and training of patients#and families.# Active RN licensure in Massachusetts and New Hampshire or willingness to obtain both required. Prior homecare or visiting nurse experience required.#IV certification and skills#required.