Certifications: Basic Life Support - American Heart AssociationAmerican Heart AssociationAmerican Heart Association, Driver License - OtherOtherOther, Registered Nurse - State of MassachusettsState of MassachusettsState of Massachusetts. The goal is to work with patients to optimize control of chronic medical and mental health conditions, improve functional status, reinforce self-management plan, and prevent/minimize long-term complications as well as to avoid unnecessary emergency room visits or hospital admissions.