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Ontario Health atHome

Provincial coordinator of home and community care

Bilingual Care Coordinator

Full-TimeDeadline 10/7/27
CA$44.48 - CA$47.52/hr
Mid
Bachelor's, Associate's
Ottawa, ON, Canada
In Person
Medical, Clinical & Veterinary

About the job

Requirements
  • Registered Nurse with a Bachelor of Science in Nursing or diploma, and registration with the College of Nurses of Ontario.
  • Degree or diploma in Physiotherapy and registration with the College of Physiotherapy of Ontario.
  • Degree or diploma in Occupational Therapy and registration with the College of Occupational Therapy of Ontario.
  • Degree in Social Work and registration with the Ontario College of Social Workers and Social Service Workers.
  • Degree in Speech Therapy and registration with the College of Audiologists and Speech-Language Pathologists of Ontario.
  • Degree in Foods and Nutrition or equivalent, and registration with the College of Dietitians of Ontario.
  • Related professional experience, normally attained over a period of two years; community-based experience is preferred.
  • Fluency in English and French is required.
  • Submit proof of COVID-19 vaccination status prior to the start date.
  • A valid driver's license and access to a vehicle are required.
  • Complete a Vulnerable Sector Check within the last six months.
Responsibilities
  • Manage a caseload of diverse patients living with or dealing with a variety of health concerns.
  • Conduct in-person visits to assess patient care needs and develop, implement, and update care plans informed by patients' health and psychosocial needs, accommodating patient and caregiver wishes where possible.
  • Determine eligibility for approved health care services and arrange those services; refer patients and caregivers to community resources and programs.
  • Connect patients in the caseload geography with care and services beyond community care, partnering with patients, families, caregivers, service providers, and other community health providers supporting patients at home.
  • Support Primary Care teams to strengthen relationships and improve communication and access to care for shared and new patients.
  • Complete comprehensive patient assessments using a validated assessment tool, including clinical, physical, psychosocial, and caregiver needs.
  • Assess patients' and caregivers' understanding and learning needs related to diagnosis, treatment, available resources, illness adjustment, and coping mechanisms.
  • Assist patients and caregivers in setting appropriate individual, joint, short-term, or long-term goals.
  • Collaborate with patients, caregivers, and the care team to develop individualized care and service plans reflecting identified priorities and desired outcomes, and identify strategies and resources to attain clinical outcomes.
  • Coordinate delivery of home and community care services to patients and caregivers.
  • Coordinate utilization of vendors and resources involving medical equipment, supplies, and services.
  • Facilitate understanding and cooperation among members of patients' multidisciplinary health care teams, communicating with team members to maximize patient outcomes.
  • Initiate and authorize implementation of care plans through contracted providers.
  • Provide reports to physicians, service providers, patients, caregivers, and other authorized parties as required.
  • Document cases in accordance with Ontario Health atHome Champlain policies.
Desired Qualifications
  • Experience working with diverse patient groups with varying levels of comprehension and language capability.
  • Ability to manage difficult conversations and situations, such as advance care planning and goals of care, in a healthy and effective manner.
  • Ability to work effectively in a team environment and independently as required.
  • Verbal and written communication skills to establish working relationships and maintain a wide range of healthcare-community partners, including doctors, nurses, and social workers.
  • Listening and facilitation skills when working with patients and caregivers.
  • Diplomacy when dealing with sensitive or confidential issues.
  • Relationship-building skills to develop and maintain health and community stakeholder partnerships.
  • Working knowledge of computer software, including email, internet, and Microsoft Office applications such as Word and Outlook.

About the company

Ontario Health atHome coordinates in-home and community-based care for patients across Ontario and manages access to long-term care home placement. Its teams assess care needs, arrange services, and connect patients and caregivers with nursing, personal support, rehabilitation, and other community resources. The organization works with hospitals, primary care providers, Ontario Health Teams, and contracted service providers to plan care and support transitions between settings. It also helps people find health and social services, navigate supportive living options, and receive palliative care in their chosen setting. The agency was formed in June 2024 by amalgamating the fourteen Home and Community Care Support Services organizations.

Company Size

5,001-10,000

Company Stage

N/A

Total Funding

N/A

Headquarters

N/A

Founded

2024

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