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Ontario Health atHome

Provincial coordinator of home and community care

Bilingual Care Coordinator - Intake

Full-TimeDeadline 10/4/27
CA$44.48 - CA$47.52
Mid
Bachelor's, Associate's
Village de Labelle, QC, Canada+3 moreMore locations: Pembroke, ON, Canada | Cornwall, ON, Canada | Ottawa, ON, Canada
In Person
Medical, Clinical & Veterinary

About the job

Requirements
  • Registered Nurse with a BScN or diploma and registration with the College of Nurses of Ontario; or a degree or diploma in Physiotherapy and registration with the College of Physiotherapy of Ontario; or a degree or diploma in Occupational Therapy and registration with the College of Occupational Therapy of Ontario; or a degree in Social Work and registration with the Ontario College of Social Workers and Social Service Workers; or a degree in Speech Therapy and registration with the College of Audiologists and Speech-Language Pathologists of Ontario; or a 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.
  • A valid driver’s license and access to a vehicle are required.
  • Fluency in English and French is required.
  • A Vulnerable Sector Check completed within the last six months is required.
Responsibilities
  • Complete comprehensive patient assessments using a validated assessment tool, including the patient’s clinical, physical, and psychosocial needs and caregiver needs.
  • Assess the patient’s and caregiver’s understanding of, and learning needs related to, diagnosis, treatment, available resources, illness adjustment, and coping mechanisms.
  • Assist the patient and caregiver in setting appropriate goals, including individual, joint, short-term, or long-term goals.
  • Collaborate with the patient, caregiver, and care team to develop an individualized care and service plan reflecting the patient’s identified priorities and desired outcomes, and identify strategies and resources to attain clinical outcomes.
  • Coordinate the delivery of home and community care services to patients and their caregivers.
  • Coordinate vendor and resource utilization involving medical equipment, supplies, and services.
  • Facilitate understanding and cooperation among members of the patient’s multidisciplinary healthcare team and communicate with team members to maximize patient outcomes.
  • Initiate and authorize implementation of the care plan through contracted providers.
  • Provide regular reports to physicians, service providers, patients, caregivers, and other authorized parties as required.
  • Document cases in accordance with Ontario Health atHome Champlain policies.
  • Manage a caseload of diverse patients living with or dealing with a variety of health concerns.
  • Assess patients’ care needs by phone and develop, implement, and update care plans informed by patients’ health and psychosocial needs, accommodating patient and caregiver wishes where possible.
  • Determine eligibility for Ontario Health atHome Champlain-approved healthcare services and arrange those services; refer patients and caregivers to other community resources and programs.
  • Use a multidisciplinary team approach to address patient needs and prioritize referrals according to complexity, urgency, and needs while following Ontario Health atHome Champlain guidelines.
Desired Qualifications
  • Community-based experience is preferred.
  • 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.
  • 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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