Full-Time
Bilingual Care Coordinator
Deadline 8/14/27
Ontario Health atHome
Coordinated home and community healthcare
Compensation Overview
CA$44.48 - CA$47.52/hr
+ Defined benefit pension plan
Ottawa, ON, Canada
In Person
This is an in-office, non-visiting role at Montfort Hospital.
Bachelor's, Associate's
Category
 Medical, Clinical & Veterinary (1) |
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Required Skills
Microsoft Office
Word/Pages/Docs
Care Coordination
Microsoft Outlook
Requirements
- Registered Nurse with a Bachelor of Science in Nursing 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
- Assess and determine patient care needs and eligibility.
- Provide access and referrals to community services and engage with patients, caregivers, and other health care practitioners.
- 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 their health and psychosocial needs while accommodating patient and caregiver wishes where possible.
- Determine eligibility for and arrange Ontario Health atHome Champlain-approved health care services and refer patients and caregivers to community resources and programs.
- Assess and develop individual patient care plans over the phone for service provision.
- Use a multidisciplinary team approach to achieve optimal health outcomes.
- Complete comprehensive patient assessments using a validated assessment tool, including clinical, physical, psychosocial, and caregiver needs.
- Assess patients' and caregivers' understanding of 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.
- Identify strategies and resources for attaining clinical outcomes.
- Coordinate the delivery of home and community care services to patients and caregivers.
- Coordinate vendor and resource utilization involving medical equipment, supplies, and services.
- Facilitate understanding and cooperation among members of patients' multidisciplinary health care teams.
- Communicate with health care team members to maximize patient outcomes.
- Initiate and authorize implementation of care plans 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.
Desired Qualifications
- Experience working with diverse patient groups with varying levels of comprehension and language capability.
- Experience managing difficult conversations and situations, such as advance care planning and goals-of-care discussions.
- Ability to work effectively in a team environment and independently as required.
- Verbal and written communication skills for establishing working relationships and maintaining partnerships within the health care community.
- Listening and facilitation skills for working with patients and caregivers.
- Diplomacy in dealing with sensitive or confidential issues.
- Relationship-building skills for developing and maintaining health and community stakeholder partnerships.
- Working knowledge of computer software, including email and internet, and Microsoft Office applications such as Word and Outlook.
Ontario Health atHome coordinates publicly funded home and community care for patients across Ontario. Its care coordinators assess needs, arrange services and connect people with nursing, therapy, personal support and other resources delivered outside hospitals. The organization also helps patients and families navigate transitions between hospital, home and community settings. Operating within Ontario’s public health system, it manages access and coordination rather than functioning as a private home-care franchise or a single clinical provider. Service delivery depends on clinical, operational and administrative teams working across its care settings.
Company Size
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Company Stage
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Total Funding
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Headquarters
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Founded
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