Care Coordinator - Complex
Join to apply for the Care Coordinator - Complex role at Ontario Health atHome.
Are you a registered nurse (RN, BScN) with experience in palliative care? You’re looking in the right place.
As a Complex Care Coordinator, you will coordinate the care and management of palliative care patients in the community. You will act as a patient advocate, affirm life, and offer supports that help patients live as actively as possible until death, with optimal quality of life.
Whether you work in our office, in the community, or a health care facility – you will play a lead role in providing connected, accessible, patient‑centered care, supported by our collaborative team that includes over 9,000 regulated health care and other professionals.
This is a temporary full‑time opportunity for 18 months.
What will you do?
- In collaboration with patients and families, assess care needs, determine eligibility for services, and develop individual care and service plans.
- Link patients with community service providers to maintain safety at home while prioritizing the prevention of hospital admissions or ED visits.
- Coordinate and monitor care plan delivery.
- Establish a helping relationship with patients and families.
- Act as a subject matter expert for colleagues and external partners regarding palliative care needs.
- Balance patient needs and choices with available resources, ensuring patient values and preferences are respected.
What must you have?
Membership, in good standing, with an applicable regulatory body as a Registered Nurse (RN, BScN).1+ years of recent experience in community health or a related field.Training / certification specific to palliative care (e.g., Fundamentals, LEAP, CAPCE).Knowledge of EDITH protocol, Symptom Response Kits, DNR‑C paperwork, and PPS Scale, as well as common prognosis and trajectories of life‑limiting conditions.Strong clinical background with a patient‑centered approach.Knowledge of the health care delivery system and community resources.Natural motivator, leader, and advocate.Excellent interpersonal, communication, assessment, problem‑solving, and decision‑making skills.Effective time management, prioritization and organizational skills, able to work independently and cooperatively in a busy multidisciplinary environment.Established ability to accurately complete required documentation, reports and forms.Valid driver’s licence and access to a reliable vehicle.Proficiency in a Windows environment.Mandatory COVID‑19 vaccination policy. All employees must submit proof of vaccination prior to the start date.What would give you the edge?
Experience working with diverse patient groups (multicultural, homeless, palliative, acquired brain injury, mental health, geriatrics, pediatrics).Case management experience or recent related community experience.Competency with RAI assessment tools.Ability to speak French or another second language.What do we offer?
Attractive comprehensive compensation packages and benefits.Valuable development opportunities.Membership in a world class defined benefit pension plan.Salary : $39.12 / hr to $51.26 / hr.Equity, Inclusion, Diversity and Anti‑Racism Commitment
Ontario Health atHome is committed to a culture of equity, inclusion, diversity and anti‑racism. We welcome and encourage applications from all qualified applicants and provide accommodations for persons with disabilities during the recruitment process.
We thank all applicants for their interest; however, only those selected for an interview will be contacted.
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