The Community Nurse, reporting to a Clinical Manager, works with residents in designated housing properties and provides residents with health education and coaching focused on self-care management, wellness, and care coordination. The residents can be members of any health plan. The Community Nurse will use their clinical skills, education, and training to optimize health outcomes for the residents. They will work with residents individually or in group settings on site at the housing property. The Community Nurse will maintain close contact and collaboration with the resident and their family members, when indicated, as well as the property coordinator, community partners, and any identified medical, behavioral, or social professionals. The Community Nurse will help residents identify and address any needs, work on identified health goals, and support their ability to age safely in their home.

• Partner with the property coordinator in creating and presenting educational activities to support healthy living.
• Based on resident preferences and identified needs, develop, create, and lead health education and wellness programs and activities to support and coach residents on healthy behavior changes and management of chronic conditions.
• In collaboration with the property coordinator, complete an initial health and wellness assessment to obtain resident health information to determine future health needs.
• Engage and encourage residents to participate in onsite health and wellness programming.
• Assist residents in self-management of their medications through education and monitoring, determine ways to adhere to medication regimes for optimal health success.
• Monitor resident vital signs and refer residents to their primary care or specialists as clinical indicated for medical intervention.
• Develop relationships with and communicate with primary care practices and other health entities to assist residents with relaying health information and coordination of care.
• Maintain all necessary clinical documentation in identified electronic system, including assessments, interactions, and any sentinel events (e.g., falls, ED visits, etc.)
• Create a safe and supportive environment and relationship with residents and property staff to encourage healthy aging in place.

• Associate degree or Diploma in nursing required, Bachelor's Degree in nursing preferred.
• Registered Nurse with licensure in good standing in the state assigned to work
• Experience in community health nursing, including previous experience in primary care setting or community-based agency required.
• 5 years' experience as Registered Nurse working with adults required.
• 2 years' experience working with adults with complex medical, behavioral health, and social needs required
• Experience in Health Education and training required.
• Experience and training in motivational interviewing and whole person care required.
• Understanding of local area healthcare services required.
• Knowledge of healthcare policies and trends preferred.
• Ability to communicate effectively with identified population, including older adults with varying cognitive abilities
• Understanding of Medicare and Medicaid including differing needs of population.
• Ability to work independently, identify priorities, and stay on task.
• Collaborative nature to partner with internal and external providers, staff, and residents.
• English required, Bilingual preferred